Objectives:To explore the clinical effects of one-stage posterior approach via multifidus-longis-simus cleavage planes for lesion debridement,bone grafting and internal fixation in the treatment of thora-columbar suppurative spondylitis in adults.Methods:73 patients with thoracic or lumbar pyogenic spondylitis who underwent one-stage posterior approach via multifidus-longissimus cleavage planes for lesion removal and bone grafting and internal fixation in the Department of Orthopedics,the Affiliated Hospital of Southwest Medical University from February 2019 to February 2021 were retrospectively analyzed.There were 52 males and 21 females,aged 35-75 years(56.5±10.7 years);T1-T10 in 15 cases,T11-L2 in 32 cases,and L3-L5 in 26 cases.Obvious kyphotic deformity was found locally in all the patients.23 cases were accompanied with intraspinal epidural abscess,and 17 cases with paravertebral or psoas major muscle abscess.7 cases were combined with neurological impairment,and the American Spinal Injury Association(ASLA)classification of neurological function was detailed in 1 case of grade C and 6 cases of grade D.24 cases were complicat-ed with cardiovascular and cerebrovascular diseases,35 cases with diabetes,and 30 cases had a history of invasive operation.The venous blood was collected for bacterial culture before operation.All the patients were treated with one-stage posterior approach via multifidus-longissimus cleavage planes for lesion removal and bone grafting and internal fixation.The lesion tissue was taken for bacterial culture during operation.The postoperative irrigation lasted for 10-14d,and the anti-infection treatment lasted for 6-8 weeks.The operative time,intraoperative blood loss,and length of hospital stays,and complications were recorded;Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and procalcitonin(PCT)were compared preoperatively and be-fore discharge;Visual analogue scale(VAS)scores of thoracolumbar back pain before operation and discharge and at final follow-up were compared.The Cobb angles of kyphosis of the lesion segment were measured on radiographs,and the rate of correction of kyphosis and loss angle of correction at the final follow-up were calculated;The recovery of spinal cord function(ASIA grade)and bone graft fusion at final follow-up were ob-served and evaluated.Results:All the patients underwent the surgery successfully.The operative time was 195.8±15.5min,the intraoperative blood loss was 562.1±45.5mL,and the length of hospital stays were 18.0±2.0d.Postoperative complications occurred in 9 patients(12.3％):2 patients had delirium syndrome,which gradually disappeared after oral administration of olanzapine;4 cases had lower limb pain and numbness,and the symptoms disappeared after nutritional nerve treatment;3 cases presented with pleural effusion and were cured after administration of closed chest drainage,anti-infection and strengthening of lung function exercises.51 cases were positive of bacterial culture,including 29 cases of Staphylococcus aureus,17 cases of Es-cherichia coli and 5 cases of Staphylococcus epidermidis.Preoperative ESR,CRP and PCT were 80.9±13.9mm/h,58.4±13.5mg/L,0.8±0.2ng/mL,and before discharge they were 29.6±8.9mm/h,15.0±7.2mg/L and 0.1±0.0ng/mL.ESR,CRP,and PCT were significantly decreased before discharge compared with preoperative values(P＜0.05).The patients were followed up for 12-30 months(20.1±4.0 months).At preoperation,before dis-charge and final follow-up,the VAS scores were 7.6±1.1,2.2±0.6 and 1.6±0.6,respectively.Before discharge and final follow-up VAS scores were significantly lower than the preoperative score(P＜0.05).The Cobb angle was 19.6°±1.6°,6.2°±1.5°,9.4°±1.0°,and the correction angle was 13.4°±0.6°,the correction rate was 68.7％±5.3％,which was significantly corrected before discharge(P＜0.05).At final follow-up,the corrected angle loss was 3.2°±0.7° relative to before discharge,and the corrected angle loss rate was 24.0％±4.6％(P＜0.05).At the final follow-up,one patient of preoperative ASIA grade C recovered to grade D,and six patients of grade D recovered to grade E.There was no change in ASLA grade after operation in patients without nerve injury before operation.Bone fusion was achieved in all patients at the final follow-up.Conclusions:On the basis of anti-infection,one-stage posterior approach via multifidus-longissimus cleavage planes for the treatment of thoracolumbar suppurative spondylitis enables removal of lesion,decompression of spinal canal,and fusion and fixation of intervertebral support implants with protection of paravertebral muscles as well as the posterior lig-amentous complexes,and reduces chronic thoracolumbar back pain after operation.

Objective:To characterize the biomechanics of distal dynamic locking and distal static locking of proximal femur bionic nails (PFBN) in fixation of intertrochanteric fractures by a finite element analysis.Methods:The CT image data from the hip to the upper tibia from an adult male volunteer were used to establish a three-dimensional model of the femur by Mimics 20.0 and Geomagic 2013 which was processed further into a model of Evans type I intertrochanteric fracture by software NX 12.0. With reference to the internal fixation parameters commonly used, 4 models of PFBN fixation were established: distal single transverse nail dynamic locking (model A), single oblique nail dynamic locking (model B), single nail static locking (model C) and double nail dynamic locking (model D). Abaqus 6.14 software was used to load and analyze the internal fixation stresses and displacements of fracture ends.Results:Under a 2100N loading, the peak stress was located upon the main nail in the 4 models. The smallest peak stress upon the main nail was in Model D (161.9 MPa), decreased by 15.9% compared with model A (192.5 MPa), by 15.6% compared with model B (191.9 MPa), and by 0.9% compared with model C (163.3 MPa). The peak stress upon the fixation screw was the largest in model A (95.3 MPa), the smallest in model B (91.5 MPa), and 91.5 MPa and 92.2 MPa in models C and D, respectively. The overall displacements of the implants, in a descending order, were 10.14 mm in model A, 10.10 mm in model B, 10.09 mm in model C, and 10.05 mm in model D. Similarly, the displacements of fracture ends were 0.125 mm in model A, 0.121 mm in model B, 0.110 mm in model C, and 0.098 mm in model D.Conclusion:Compared with dynamic locking, distal static locking of PFBN provides a better mechanical stability and reduces stress concentration upon internal fixation.

Objective To discuss the effect of multidisciplinary family empowerment mode in home care for patients after receiving percutaneous endoscopic gastrostomy(PEG).Methods A total of 86 patients,who received initial PEG at the Jilin Provincial Cancer Hospital of China from January 2021 to July 2023,were selected for this study.The patients were randomly divided into observation group.The patients of the control group received routine nursing guidance for gastrostomy,while the patients of the observation group received multidisciplinary family empowerment nursing mode.The self-care ability[using self-care ability scale of the elderly(SASE)score],health behavior ability[using self-rating scale of health behavior ability(SRAHP)score],incidence of complications,and healing time of complications were compared between the two groups.Results In the observation group the SASE[(129.48±5.48)points vs.(73.05±12.04)points]and the SRAHP[(80.14±1.00)points vs.(70.25±7.92)points]were significantly higher than those in the control group(all P＜0.05),the incidence of complications was lower than that in the control group,and the healing time of complications was shorter than that in the control group.Conclusion The implementation of multidisciplinary family empowerment nursing mode can improve the self-care ability and health behavior ability of patients after receiving PEG,reduce postoperative complications,as well as shorten the healing time of complications,therefore,this nursing mode is suitable for home patients after receiving PEG.

Objective : To investigate the role and mechanism of bone formation caused by the ratio of advanced platelet-rich fibrin (A-PRF) and β-tricalcium phosphate (β-TCP) in rabbit femur defect model, which provides a new idea for clinical treatment of bone defect. Methods : Twenty-four New Zealand white rabbits were divided into model group, 1∶1 complex group (A-PRF∶β-TCP=1∶1), 2∶1 complex group (A-PRF∶β- TCP=2∶1) and 4∶1 complex group (A-PRF∶β- TCP=4∶1）, with 6 rabbits in each group. Femoral defect models were constructed in each group. In the composite group, the bone defect was filled with composite material, while in the model group, no material was filled. After 8 weeks, the animals were euthanized and specimens were collected. Bone mineral density (BMD), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.SP) and trabecular number (Tb.N) in femoral defect tissue were measured by micro-CT and photographed. Hematoxylin - eosin staining was used to detect the pathological changes of new bone tissue. The morphological changes of the new bone tissue were observed by scanning electron microscopy. Determination of phospho-mitogen activated protein kinase p38 (p-p38MAPK), CCAAT/enhancer binding protein homologous protein (CHOP) and phospho-cysteine aspartic protease-3 (p-Caspase3) in newborn femur by ELISA. The mRNA expressions of osteoprotegerin (OPG), bone morphogenetic protein-2 (BMP-2), receptor activator of nuclear factor kappa-B ligand (RANKL) and p38MAPK were detected by real-time quantitative PCR. The expression of OPG, BMP-2, RANKL, p-p38MAPK and p-Caspase3 protein in the new bone tissue was observed by immunohistochemistry. Results : In the model group, bone formation in the femoral defect area was slow and osteogenic quality was poor. Compared with the model group, the bone formation and neocapillaries of femoral defect area in the complex group was good, BMD, BV.TV, Tb.Th, Tb.N were increased, and Tb.Sp were decreased, the expressions of p-p38MAPK, CHOP and p-Caspase3 were decreased, and the mRNA and protein expressions of OPG and BMP-2 were increased. The mRNA expression of RANKL and p38MAPK was decreased. Apoptosis in new bone tissue of each group showed the lowest apoptosis rate in samples of the 2∶1 complex group (P<0.05); A-PRF: β-TCP=2∶1 ratio has the best osteogenic effect. Conclusion The complex composed of A-PRF and β-TCP can promote the expression of OPG, inhibit the expression of RANKL and phosphorylation of p38MAPK, reduce the apoptosis of new bone tissue cells, and promote osteogenic differentiation.

Humans ; Charcot-Marie-Tooth Disease/complications* ; Hoarseness/etiology*

After more than 100 years of development， spray drying technology has become more mature and widely used， and it is of great importance in the field of traditional Chinese medicine （TCM）. TCM powders prepared by spray drying is the raw material of dispensing granules， and the powder properties have an important influence on subsequent molding process and product quality. As a new form of TCM， dispensing granules have been included in the management category of TCM decoction pieces， indicating a broader application market， and a consensus has also been reached on the importance of TCM powder research. Based on this， the author summarized the application progress of spray drying in the study of TCM powders， including the factors affecting spray drying process， such as liquid properties， process parameters and equipment factors， as well as the application of computational fluid dynamics （CFD） and thermodynamic model in spray drying process simulation. Moreover， some commonly used pharmaceutical excipients for the modification of TCM powders were also introduced such as maltodextrin， microcrystalline cellulose and povidone. In addition， spray drying technology can also be used as a preparation technology for new drug delivery systems such as microcapsules and solid dispersions. Through the summary of this paper， the author suggests that the future research direction of spray drying of TCM can be carried out from the aspects of application rule of the coprocessing auxiliary materials based on the "unification of medicines and excipients"， the "structure-property" relationship of spray-dried powders and the application of computer simulation and design， so as to further enrich the application of spray drying in the field of TCM powders.

BACKGROUND: Insufficient cerebral perfusion is suggested to play a role in the development of Alzheimer disease (AD). However, there is a lack of direct evidence indicating whether hypoperfusion causes or aggravates AD pathology. We investigated the effect of chronic cerebral hypoperfusion on AD-related pathology in humans. METHODS: We enrolled a group of cognitively normal patients (median age: 64 years) with unilateral chronic cerebral hypoperfusion. Regions of interest with the most pronounced hypoperfusion changes were chosen in the hypoperfused region and were then mirrored in the contralateral hemisphere to create a control region with normal perfusion. 11C-Pittsburgh compound-positron emission tomography standard uptake ratios and brain atrophy indices were calculated from the computed tomography images of each patient. RESULTS: The median age of the 10 participants, consisting of 4 males and 6 females, was 64 years (47-76 years). We found that there were no differences in standard uptake ratios of the cortex (volume of interest [VOI]: P = 0.721, region of interest [ROI]: P = 0.241) and grey/white ratio (VOI: P = 0.333, ROI: P = 0.445) and brain atrophy indices (Bicaudate, Bifrontal, Evans, Cella, Cella media, and Ventricular index, P > 0.05) between the hypoperfused regions and contralateral normally perfused regions in patients with unilateral chronic cerebral hypoperfusion. CONCLUSION Our findings suggest that chronic hypoperfusion due to large vessel stenosis may not directly induce cerebral β-amyloid deposition and neurodegeneration in humans.
Aged ; Alzheimer Disease/pathology* ; Amyloid beta-Peptides/metabolism* ; Arteries ; Atrophy ; Brain/metabolism* ; Cerebral Cortex/metabolism* ; Cerebrovascular Circulation ; Constriction, Pathologic/pathology* ; Female ; Humans ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Positron-Emission Tomography/methods*

Objective:To investigate the clinical effect and short-term and long-term effect of total hip replacement (THA) and hemiarthroplasty of hip (HA) in elderly patients with femoral neck fracture (FNF).Methods:59 elderly patients with FNF in South District of Guang′anmen Hospital, Chinese Academy of Traditional Chinese Medicine from March 2017 to January 2019 were retrospectively analyzed. The observation group ( n=29) was treated with THA; The control group ( n=30) was treated with HA. The operation related indexes, short-term and long-term clinical effect (average follow-up of 24.1 months), hip function improvement, pain and complications were compared between the two groups. Short term and long-term clinical effects: the short-term and long-term clinical effects of the two groups were observed by the Harris Hip Score (HHS) of the first month, the third month, the sixth month, the ninth month and the first year after operation. Results:Both THA and HA were effective on elderly FNF, but the effective rate of THA (96.6%) was significantly higher than that of HA (90.0%), with statistically significant difference ( P<0.05); in terms of operation related indicators, compared with the control group, the observation group had longer operation time [ (104.46±3.24)min vs (84.34±3.64)min], more amount of bleeding [(296.64±15.16)ml vs (281.44±12.16)ml], lower postoperative drainage volume [(101.24±4.15)ml vs (74.56±3.24)ml], while the functional recovery of the observation group was better than the control group by HHS ( P<0.05); the postoperative complications and HHS score of observation group were significantly lower than the control group ( P<0.05). Conclusions:THA has the advantages of low complication, fast functional recovery and better effect. The clinical decision should be based on the patient′s physical condition. THA should be used for elderly patients with good basic condition, good surgical tolerance and more daily activities. HA should be used for elderly patients with poor basic condition, low surgical tolerance and less daily activities.

OBJECTIVE： To prepare pogostone transfersomes， and to evaluate its quality. METHODS： Film dispersion method was used to prepare pogostone transfersomes. Using the accumulative penetration volume （Qn） and accumulative penetration ratio （PR） of pogostone as evaluation indexes， the types of surfactant， formulation were screened in respects of the dosage of surfactant and the dosage of pogostone. The pogostone transfersomes were prepared with optimal formulation； the morphology， particle size distribution and Zeta potential were observed and the entrapment efficiency was measured. RESULTS： The optimal formulation was as follows as the sodium cholate was selected as surfactant； the dosage of sodium cholate was 0.25 g； the dosage of pogostone was 15 mg. The optimal pogostone transfersomes were ivory-white suspension； average particle size was （115.6±3.65） nm （RSD＝3.20％，n＝3）； PDI was 0.185±0.008 （RSD＝4.30％， n＝3）； Zeta potential was （－13.76±0.225） mV （RSD＝1.70％，n＝3）； entrapment efficiency of pogostone was （46.01±0.40）％ （RSD＝0.87％，n＝3）； Qn was （378.76±0.61）   μg/cm2 （RSD＝0.20％，n＝3）； PR was （89.02±0.96）％ （RSD＝1.10％，n＝3）. CONCLUSIONS： Prepared pogostone transfersomes are in line with quality requirements， which can provide reference for the further study of new dosage form of pogostone.

Objective To compare and analyze the epidemiological features of adult talus fractures between East China and West China from 2010 to 2011.Methods The data of adult talus fractures from January 2010 to December 2011 in 63 hospitals in East China and West China were collected through the PACS system and medical records systems.The data of 35 hospitals in East China were assigned into group A while the data of 28 hospitals in West China into group B.The analytic items included gender,age,and type of AO classification.Results A total of 1,014 cases were collected.In group A of 825 cases,there were 624 (75.64％) males and 201 (24.36％) females;in group B of 189 cases,there were 130 (68.78％)males and 59 (31.22％) females.There was no significant difference between groups A and B in male to female ratio (x2 =3.788,P=0.052).The mean age was 36 years old (26,47) in group A and 35 (24,48) years old in group B,showing no significant difference between the 2 groups (Z =-8.244,P ＜ 0.001).There was a significant difference between the 2 groups in the constituent ratio of age ranges (P ＜ 0.05).The peak age range was from 21 to 30 years old in group A (27.76％,229/825),and from 31 to 40 years old in group B (24.34％,46/189).The high-risk type of fracture was AO type 81-A in both groups.Conclusions There were more male talus fractures than female ones in both East China and West China.Most talus fractures happened in patients aged from 21 to 30 years in East China and in patients aged from 31 to 40 years in West China.AO Type 81-A was the most common in both West and East China.