BACKGROUND:The individualized precise puncture approach is a new approach proposed for vertebral body augmentation in recent years,and has achieved good clinical results,but there is still a lack of relevant biomechanical research.OBJECTIVE:To investigate the biomechanical effects of individualized precise puncture vertebral augmentation on the vertebral endplate and intervertebral disc of osteoporotic vertebral compression fracture using finite element analysis method.METHODS:A total of six preoperative and postoperative models of wedge type,biconcave type,and collapse type were established using the preoperative and postoperative CT imaging data of three osteoporotic vertebral compression fracture patients who had completed individualized precise puncture vertebral augmentation.500 N moment and 10 N/m rotation moment were loaded in the vertical direction of the vertebral body to simulate the normal physiological activities of the vertebral body,including forward flexion,back extension,left bending,right bending,left rotation,and right rotation,to observe the stress changes of endplates,adjacent endplates,and intervertebral discs of different types of fractured vertebral bodies after individualized precise puncture vertebral augmentation.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)After individualized precise puncture vertebral augmentation,the maximum von Mises stress values of wedge-shaped,biconcave,and collapsed fractured vertebral endplates and adjacent vertebral endplates were reduced to a certain extent.The postoperative maximum von Mises stress value increased in the T10 inferior endplate of the superior vertebral body with wedge deformity and the L1 superior endplate of the inferior vertebral body with collapsed deformity.(3)After individualized precise puncture vertebral augmentation,the overall maximum von Mises stress value of adjacent intervertebral discs in the three finite element models decreased.(4)The results show that individualized precise puncture vertebral augmentation can reduce the maximum von Mises stress value of the endplate of wedge-shaped deformity,biconcave deformity and collapsed vertebral body to a certain extent,and diminish the risk of postoperative vertebral body re-fracture.In addition,individualized precise puncture vertebral augmentation decreases the maximum von Mises stress value of the intervertebral disc,which can theoretically alleviate intervertebral disc degeneration to a certain extent.

Objective:To evaluate the safety and feasibility of double-port laparoscopic cholecystectomy (LC) combined with transcystic common bile duct (CBD) exploration using ultrafine choledochoscopy on patients with gallbladder stones and common bile duct stones.Methods:Clinical data of 35 patients undergoing double-port LC combined with transcystic CBD exploration using ultrafine choledochoscopy in Anhui No.2 Provincial People’s Hospital from December 2021 to June 2024 were retrospectively analyzed, including 8 males and 27 females, aged (45.8±18.1) years. In all patients, the diameter of the gallbladder duct was greater than 3 mm, the maximum diameter of the stones was less than 10 mm, and the number of stones was less than 5, and the gallbladder ducts were normal. Magnetic resonance cholangiopancreatography (MRCP) was used to measure the diameter of CBD, the number and the maximum diameter of stones. The operative time, intraoperative blood loss, postoperative anal exhaust time, postoperative hospital stay and complications (including abdominal infection, biliary tract infection, bile leakage, bleeding, etc.) of all patients were analyzed. The incidence of bile duct stenosis, residual stone or stone recurrence were followed up by telephone or outpatient review.Results:MRCP measurement indicated that the common bile duct diameter of patients was (8.1±1.3) mm. Single CBD stone occurred in 27 cases (77.1%, 27/35), and the mean maximum diameter of CBD stones was (3.9±1.3) mm. All patients successfully underwent the procedure. The operative time was (80.1±10.9) min, the intraoperative blood loss was (25.5±10.2) ml, the recovery time of postoperative anal exhaust was (17.3±4.7) h, and the postoperative hospital stay was (2.5±0.6) d. There were no complications such as abdominal and biliary tract infection, bile leakage and bleeding. All patients were followed up for 1-30 months, with a median follow-up time of 12 months. No biliary stricture, residual stones or recurrence occured during the follow-ups.Conclusion:In selected cases, double-port LC combined with transcystic CBD exploration using ultrafine choledochoscopy could be safe and feasible, with less trauma, quick recovery and short operative time.

BACKGROUND:Pedicle internal bone cement augmentation combined with vertebroplasty has been used to treat diseases such as Kummell's disease and osteolytic metastases of the pedicle.However,the impact of this surgical method on adjacent vertebrae and intervertebral discs remains unclear.OBJECTIVE:A three-dimensional finite element model was used to explore the impact of percutaneous vertebroplasty combined with pedicles augmentation in the treatment of severe osteoporotic vertebral fractures on the biomechanics of adjacent segmental vertebral bodies and intervertebral discs.METHODS:A female patient who had undergone percutaneous vertebroplasty combined with pedicles augmentation for a severe osteoporotic vertebral fracture(L1)was selected.Preoperative and postoperative CT files were extracted.The study range was T12 to L2,including the injured vertebra,adjacent vertebrae,and intervertebral discs.Software like Mimics,SolidWorks,and Geomagic was used to establish finite element models of the spinal functional unit before and after surgery.A 500 N force and a 10 N·m rotational torque were applied in the vertical direction of the T12 upper endplate to simulate movements such as flexion,extension,lateral bending,and rotation,analyzing the stress changes in the vertebral endplates and intervertebral discs of adjacent segments before and after surgery.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)We calculated and analyzed that under simulated load,the stress distribution of the inferior endplate of T12 was more uniform and the maximum stress value was reduced after surgery,with no significant difference compared with before surgery(P＞0.05).The stress distribution of the superior endplate of L2 after surgery was more uniform and the maximum stress was not significantly different from that before surgery(P＞0.05).Similarly,the stress distribution of T12/L1 and L1/L2 intervertebral discs after surgery was also more uniform and the maximum stress value was significantly reduced(P＜0.05).(3)Therefore,percutaneous vertebroplasty combined with pedicles augmentation can effectively improve the stress distribution of adjacent vertebral endplates and intervertebral discs after surgery and reduce stress,ultimately reducing the risk of postoperative re-fractures and significantly delaying intervertebral disc degeneration.

BACKGROUND:The blood-brain barrier is an important structure that protects the central nervous system,and the study of the effects of high glucose on the blood-brain barrier is important for the prevention of high glucose-induced damage to the central nervous system.OBJECTIVE:To investigate the potential effect of high glucose on the blood-brain barrier function of hCMEC/D3 human brain microvascular endothelial cells.METHODS:hCMEC/D3 cells were cultured in regular sugar medium(glucose concentration of 25 mmol/L)and high-sugar medium(glucose concentration of 55 mmol/L).The morphology of cells in each group was observed by light microscopy.CCK-8 assay was used to detect changes in cell viability.A monolayer blood-brain barrier model was established using hCMEC/D3 cell line with Transwell chamber device.Changes in cell transmembrane resistance were monitored daily.The permeability of cell monolayers was detected by phenol red permeability.Flow cytometry was used to detect the apoptosis rate of the cells.Western blot assay was used to detect the expression of Bcl-2,Bax,Caspase-3,ZO-1,Occludin,Claudin-1,and histone deacetylase 4.The levels of histone deacetylase in cell supernatant were detected by ELISA.The expression of histone deacetylase 4 in cells was detected by immunofluorescence.RESULTS AND CONCLUSION:(1)The cell viability of high sugar group was significantly lower than that of control group(P＜0.000 1).(2)The cells of the control group were in a good growth state,interwoven into a dense mesh,with interconnections between synapses.The cell growth of high glucose group was suppressed,and the connection of inter-cellular synapses was reduced.(3)Compared with the control group,the transmembrane resistance value of the high glucose group was reduced(P＜0.05);phenol-red permeability of the monolayer cell membrane was increased(P＜0.05);cell apoptosis rate was increased(P＜0.01);the expression of Bax protein was increased(P＜0.000 1);the expression of Caspase-3 protein had no significant change(P＞0.05);the expression of Bcl-2,ZO-1,Occludin,Claudin-1,and histone deacetylase 4 proteins was decreased(P＜0.01,P＜0.001,P＜0.01,P＜0.000 1,P＜0.01);the fluorescence expression of histone deacetylase 4 was decreased(P＜0.001)in the high glucose group.(4)The level of histone deacetylase 4 in the cell supernatant of the high glucose group was lower than that of the control group(P＜0.05).The results show that high glucose induces the increased apoptosis and enhances permeability of hCEMCE/D3 cells,and its mechanism may be related to the decreased expression level of histone deacetylase 4.

BACKGROUND:The blood-brain barrier is an important structure that protects the central nervous system,and the study of the effects of high glucose on the blood-brain barrier is important for the prevention of high glucose-induced damage to the central nervous system.OBJECTIVE:To investigate the potential effect of high glucose on the blood-brain barrier function of hCMEC/D3 human brain microvascular endothelial cells.METHODS:hCMEC/D3 cells were cultured in regular sugar medium(glucose concentration of 25 mmol/L)and high-sugar medium(glucose concentration of 55 mmol/L).The morphology of cells in each group was observed by light microscopy.CCK-8 assay was used to detect changes in cell viability.A monolayer blood-brain barrier model was established using hCMEC/D3 cell line with Transwell chamber device.Changes in cell transmembrane resistance were monitored daily.The permeability of cell monolayers was detected by phenol red permeability.Flow cytometry was used to detect the apoptosis rate of the cells.Western blot assay was used to detect the expression of Bcl-2,Bax,Caspase-3,ZO-1,Occludin,Claudin-1,and histone deacetylase 4.The levels of histone deacetylase in cell supernatant were detected by ELISA.The expression of histone deacetylase 4 in cells was detected by immunofluorescence.RESULTS AND CONCLUSION:(1)The cell viability of high sugar group was significantly lower than that of control group(P＜0.000 1).(2)The cells of the control group were in a good growth state,interwoven into a dense mesh,with interconnections between synapses.The cell growth of high glucose group was suppressed,and the connection of inter-cellular synapses was reduced.(3)Compared with the control group,the transmembrane resistance value of the high glucose group was reduced(P＜0.05);phenol-red permeability of the monolayer cell membrane was increased(P＜0.05);cell apoptosis rate was increased(P＜0.01);the expression of Bax protein was increased(P＜0.000 1);the expression of Caspase-3 protein had no significant change(P＞0.05);the expression of Bcl-2,ZO-1,Occludin,Claudin-1,and histone deacetylase 4 proteins was decreased(P＜0.01,P＜0.001,P＜0.01,P＜0.000 1,P＜0.01);the fluorescence expression of histone deacetylase 4 was decreased(P＜0.001)in the high glucose group.(4)The level of histone deacetylase 4 in the cell supernatant of the high glucose group was lower than that of the control group(P＜0.05).The results show that high glucose induces the increased apoptosis and enhances permeability of hCEMCE/D3 cells,and its mechanism may be related to the decreased expression level of histone deacetylase 4.

BACKGROUND:The individualized precise puncture approach is a new approach proposed for vertebral body augmentation in recent years,and has achieved good clinical results,but there is still a lack of relevant biomechanical research.OBJECTIVE:To investigate the biomechanical effects of individualized precise puncture vertebral augmentation on the vertebral endplate and intervertebral disc of osteoporotic vertebral compression fracture using finite element analysis method.METHODS:A total of six preoperative and postoperative models of wedge type,biconcave type,and collapse type were established using the preoperative and postoperative CT imaging data of three osteoporotic vertebral compression fracture patients who had completed individualized precise puncture vertebral augmentation.500 N moment and 10 N/m rotation moment were loaded in the vertical direction of the vertebral body to simulate the normal physiological activities of the vertebral body,including forward flexion,back extension,left bending,right bending,left rotation,and right rotation,to observe the stress changes of endplates,adjacent endplates,and intervertebral discs of different types of fractured vertebral bodies after individualized precise puncture vertebral augmentation.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)After individualized precise puncture vertebral augmentation,the maximum von Mises stress values of wedge-shaped,biconcave,and collapsed fractured vertebral endplates and adjacent vertebral endplates were reduced to a certain extent.The postoperative maximum von Mises stress value increased in the T10 inferior endplate of the superior vertebral body with wedge deformity and the L1 superior endplate of the inferior vertebral body with collapsed deformity.(3)After individualized precise puncture vertebral augmentation,the overall maximum von Mises stress value of adjacent intervertebral discs in the three finite element models decreased.(4)The results show that individualized precise puncture vertebral augmentation can reduce the maximum von Mises stress value of the endplate of wedge-shaped deformity,biconcave deformity and collapsed vertebral body to a certain extent,and diminish the risk of postoperative vertebral body re-fracture.In addition,individualized precise puncture vertebral augmentation decreases the maximum von Mises stress value of the intervertebral disc,which can theoretically alleviate intervertebral disc degeneration to a certain extent.

BACKGROUND:Pedicle internal bone cement augmentation combined with vertebroplasty has been used to treat diseases such as Kummell's disease and osteolytic metastases of the pedicle.However,the impact of this surgical method on adjacent vertebrae and intervertebral discs remains unclear.OBJECTIVE:A three-dimensional finite element model was used to explore the impact of percutaneous vertebroplasty combined with pedicles augmentation in the treatment of severe osteoporotic vertebral fractures on the biomechanics of adjacent segmental vertebral bodies and intervertebral discs.METHODS:A female patient who had undergone percutaneous vertebroplasty combined with pedicles augmentation for a severe osteoporotic vertebral fracture(L1)was selected.Preoperative and postoperative CT files were extracted.The study range was T12 to L2,including the injured vertebra,adjacent vertebrae,and intervertebral discs.Software like Mimics,SolidWorks,and Geomagic was used to establish finite element models of the spinal functional unit before and after surgery.A 500 N force and a 10 N·m rotational torque were applied in the vertical direction of the T12 upper endplate to simulate movements such as flexion,extension,lateral bending,and rotation,analyzing the stress changes in the vertebral endplates and intervertebral discs of adjacent segments before and after surgery.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)We calculated and analyzed that under simulated load,the stress distribution of the inferior endplate of T12 was more uniform and the maximum stress value was reduced after surgery,with no significant difference compared with before surgery(P＞0.05).The stress distribution of the superior endplate of L2 after surgery was more uniform and the maximum stress was not significantly different from that before surgery(P＞0.05).Similarly,the stress distribution of T12/L1 and L1/L2 intervertebral discs after surgery was also more uniform and the maximum stress value was significantly reduced(P＜0.05).(3)Therefore,percutaneous vertebroplasty combined with pedicles augmentation can effectively improve the stress distribution of adjacent vertebral endplates and intervertebral discs after surgery and reduce stress,ultimately reducing the risk of postoperative re-fractures and significantly delaying intervertebral disc degeneration.

Objective:To evaluate the safety and feasibility of double-port laparoscopic cholecystectomy (LC) combined with transcystic common bile duct (CBD) exploration using ultrafine choledochoscopy on patients with gallbladder stones and common bile duct stones.Methods:Clinical data of 35 patients undergoing double-port LC combined with transcystic CBD exploration using ultrafine choledochoscopy in Anhui No.2 Provincial People’s Hospital from December 2021 to June 2024 were retrospectively analyzed, including 8 males and 27 females, aged (45.8±18.1) years. In all patients, the diameter of the gallbladder duct was greater than 3 mm, the maximum diameter of the stones was less than 10 mm, and the number of stones was less than 5, and the gallbladder ducts were normal. Magnetic resonance cholangiopancreatography (MRCP) was used to measure the diameter of CBD, the number and the maximum diameter of stones. The operative time, intraoperative blood loss, postoperative anal exhaust time, postoperative hospital stay and complications (including abdominal infection, biliary tract infection, bile leakage, bleeding, etc.) of all patients were analyzed. The incidence of bile duct stenosis, residual stone or stone recurrence were followed up by telephone or outpatient review.Results:MRCP measurement indicated that the common bile duct diameter of patients was (8.1±1.3) mm. Single CBD stone occurred in 27 cases (77.1%, 27/35), and the mean maximum diameter of CBD stones was (3.9±1.3) mm. All patients successfully underwent the procedure. The operative time was (80.1±10.9) min, the intraoperative blood loss was (25.5±10.2) ml, the recovery time of postoperative anal exhaust was (17.3±4.7) h, and the postoperative hospital stay was (2.5±0.6) d. There were no complications such as abdominal and biliary tract infection, bile leakage and bleeding. All patients were followed up for 1-30 months, with a median follow-up time of 12 months. No biliary stricture, residual stones or recurrence occured during the follow-ups.Conclusion:In selected cases, double-port LC combined with transcystic CBD exploration using ultrafine choledochoscopy could be safe and feasible, with less trauma, quick recovery and short operative time.

Objective:To investigate the microsurgical efficacy of large primary intracranial solitary fibrous tumor and influencing factors for its prognoses.Methods:From January 2010 to December 2022, 47 patients with large primary intracranial solitary fibrous tumor admitted to and accepted microsurgery in Department of Neurosurgery, Wuhan Central Hospital and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, were enrolled. The clinical data, microsurgical efficacy and follow-up results of these patients were retrospectively analyzed, and influencing factors for total resection and prognoses were determined.Results:Thirty-two patients had tumor within the supratentorial region and 15 in the mandibular region, including 24 with sinus involved tumor. According to 2021 WHO Classification of Tumors of the Central Nervous System, 5 patients (10.6%) had grading 1, 32 (68.1%) grading 2, and 10 (21.3%) grading 3. Total resection was achieved in 31 patients (66.0%) and subtotal resection in 16 patients (34.0%). Postoperative complications, such as intraoperative hemorrhage, distant epidural hematoma and subcutaneous effusion, occurred in 7 patients (14.9%) and they were cured after secondary hematoma removal or conservative treatment; residual limb mobility disorder occurred in 3 patients, visual impairment in 3, and postoperative seizures in 2. Adjuvant radiotherapy was performed in 13 patients (27.7%). Follow-up was performed for (69.1±29.6) months and 29 patients (61.7%) had recurrent tumors (6 with intracranial and extracranial metastases and 4 deaths). Mean progression-free survival was (57.5±25.1) months; the 1-, 3-, and 5-year progression-free survival rates were 95.7%, 87.2%, and 59.6%, respectively. Sinus involvement was the independent influencing factor for total tumor resection; and total resection was an independent protective factor for progression-free survival for large primary intracranial solitary fibrous tumor ( HR=4.291, 95% CI: 1.555-11.838, P=0.005). Conclusion:Patients with large primary intracranial solitary fibrous tumor have a high recurrent risk after surgery; and gross-total resection should be strived to prevent tumor recurrence.

Objective:To study the effects of plan-do-check-action (PDCA) cycle in quality improvement of neonatal resuscitation.Methods:From 2016 to 2020, the clinical data of neonates born in our hospital were analyzed. Neonates born during 2016 to 2017 were pre-PDCA group and neonates born during 2018 to 2020 were post-PDCA group. PDCA quality improvement included step-by-step, high-frequency and low-dose training, strengthening teamwork and adding equipment.Results:A total of 7 728 live-birth neonates were delivered before PDCA with 319 cases (4.1%) of asphyxia. 10 174 live-birth neonates were delivered after PDCA with 422 cases (4.1%) of asphyxia. The asphyxia rates showed no significant difference between the two groups ( P>0.05). The incidences of severe asphyxia before and after PDCA were both 0.8% without significant difference ( P>0.05). The success rates of resuscitation for severe asphyxia before and after PDCA was 27.9% and 44.9%, respectively, and the differences were statistically significant ( P<0.05). The mortality rates within 7 d before and after PDCA were 0.5‰ and 0.1‰ respectively, without significant differences ( P>0.05). Conclusions:The implementation of PDCA cycle and step-by-step, high-frequency, low-dose neonatal resuscitation training can effectively improve the success rate of resuscitation in newborns with severe asphyxia.