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: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 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: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.

To evaluate the feasibility of magnetic navigation ultrasonography system in guiding the puncture of percutaneous posterior endoscopic cervical discectomy ( PPECD ) . Methods T he cervical CT data of 6 patients with cervical spondylosis were used to made 3D printing model ,then the localized puncture of the model was guided by the magnetic navigation ultrasonography system ,1‐mm‐slice transection CT scans were obtained to confirm the placement of the needle tips after puncture . T he total puncture time and the distance between the pinpoint in the lateral and longitudinal directions from the ＂V point＂were recorded . Results All the 36 puncture operations accurately located the target segment without penetrating the spinal canal . T he average lateral distance of the needle tip from the ＂V point＂was 2 .88 mm ( 0－7 .12 mm ) ,meanw hile the average longitudinal distance was 1 .64 mm ( 0 －4 .45 mm ) ,and the the w hole process took 3 .72 min( 2 .42－5 .20 min) . T hirty‐three of 36 points were in the circle with ＂V point＂as the center and 5mm as the radius ,puncture success rate was 91% . Conclusions T he puncture model established in this study can be used as a teaching tool ,magnetic navigation ultrasonography system has successfully guided the posterior cervical intervertebral disc puncture on the model ,and there is no radiation exposure during the operation process ,which has a promising clinical application prospect .

Objective: To investigate the potential risk factors for influencing renal recovery at discharge in critically ill patients with acute kidney injury (AKI) requiringcontinuous renal replacement therapy (CRRT). Methods: This was a single-center, retrospective study. Critically ill patients with AKI requiring CRRT adimitted to the Department of Intensive Care Unit (ICU) in Taizhou Municipal Hospital, Zhejiang province, from June 2014 to December 2017 were included and divided into two groups according to the status of renal recovery at discharge as renal recovery group and renal non-recovery group. The data of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score at adimission to ICU, initial serum creatinine (initial SCr) and lactate level and initial estimated glomerular filtration rate (initial eGFR) at time of AKI diagnosis, and total time of RRT and duration of anuria before CRRT were analyzed. Length of ICU stay and length of hospital stay in both groups were also analyzed. Multivariate logistic regression was taken to analyze the potential risk factors for influencing renal recovery at discharge in critically ill patients with AKI. Results: A total of 115 critically ill patients with AKI requiring CRRT were included, of which whom 45 cases were in renal recovery group and 70 cases were in renal non-recovery group, and the renal recovery rate at discharge was 39.1%(45/115); 59 patients were dead during hospitalization and the hospital mortality was 51.3%(59/115). Compared with renal non-recovery group, renal recovery group have a lower value of APACHEⅡ score [(21.73 ± 2.66) scores vs. (23.19 ± 4.41) scores, P=0.03), SOFA score [(11.02 ± 2.22) scores vs. (12.79 ± 2.82) scores, P=0.001], lactate level [(3.82 ± 1.34) mmol/L vs. (4.47 ± 1.52) mmol/L, P=0.021], initial SCr [(2.151 ± 0.677) mg/dl vs. (2.505 ± 0.792) mg/dl, P=0.015], duration of anuria before CRRT[(11.80 ± 4.71) h vs. (19.11 ± 5.98) h, P=0.005] and total time of RRT [(8.64 ± 3.42) d vs. (15.81 ± 5.07) d, P=0.001], and have a higher value of initial eGFR [(36.26 ± 14.74) ml/(min·1.73 m²) vs. (30.07 ± 10.38) ml/(min·1.73 m²), P=0.009]. In addition, length of ICU stay [(12.58 ± 4.78) d vs. (15.30 ± 5.45) d, P=0.007] and length of hospital stay [(19.58 ± 6.44) d vs. (22.11 ± 5.90) d, P=0.032] in renal recovery group were also significantly lower than those in renal non-recovery group. Multivariate logistic regression analysis indicated that SOFA score (OR=0.700, 95% CI 0.521-0.941, P=0.018), duration of anuria before CRRT (OR=0.782, 95%CI 0.689-0.888,P < 0.01) and total time of RRT (OR=0.673, 95% CI 0.565-0.801; P < 0.01) were independent risk factors influencing renal recovery at discharge in critically ill patients with AKI, and initial eGFR was a independent protective factor. Conclusions As to critically ill patients with AKI requiring CRRT, there are many factors that affect renal recovery at discharge,. SOFA score, duration of anuria before CRRT and total time of RRT are independent risk factors, and initial eGFR is an independent protective factor.

Objective To investigate the clinical efficacy of low molecular weight heparin combined with ginkgo dipyridamole on the patients with acute cardiogenic cerebral embolism .Methods Eighty cases of cardiogenic cerebral embolism admitted into the Department of Neurology of the hospital from July 2015 to July 2016 were recruited as research subjects .With the knowledge of the pa-tients and consent of their dependents , the patients were equally divided into 2 groups: the observation group and the control group , each consisting of 40 patients.After admission into the hospital , the patients of the 2 groups were given the same basic treatment and the treatment for complication prevention .The patients of the observation group received treatment of low molecular weight heparin com -bined with ginkgo dipyridamole for the treatment of acute cardiogenic cerebral embolism , while the patients of the control group were just given low molecular weight heparin .Recovery of neurological insufficiency and clinical efficacy were compared between the 2 groups both before and after treatment , and at the same time, adverse reactions were also observed and compared between the 2 groups.Results After treatment, the neurological function scores of the observation group were significantly higher than those of the control group , and statistical significance could be seen when comparisons were made between them (P<0.05).Total therapeutic efficacy of the observa-tion group was 97.5%, which was significantly higher than that of the control group (67.5%), also with statistical significance (P<0.05).There was no statistical significance in adverse reactions , when comparisons were made between the 2 groups(P>0.05). Conclusion Low molecular weight heparin combined with ginkgo dipyridamole in the treatment of acute cardiogenic cerebral embolism could produce much better effect than single application of low molecular weight heparin .

Long-term medical education program requires that the medical students should ac-quire both professional knowledge and scientific research ability. These students,with heavy task and course,have difficulty in performing the scientific research systematically. It is very important to develop the early scientific research training. Department of pathology in Central South University,took early sci-entific research activities in various forms,such as literature searching,reviews writing,research design-ing,experiment performing,lecture communicating and clinical practicing after combining the discipline characteristic and arranging the overall process. Satisfactory effects were achieved with efforts.