OBJECTIVE: To compare the efficacy of percutaneous pedicle screw combined with unilateral nail placement combined with bone cement strengthening and bilateral nail placement in the treatment of osteoporotic thoracic and lumbar fractures. METHODS: A retrospective case-control study was used to analyze the clinical data of 78 patients with osteoporotic thoracic and lumbar fractures admitted from October 2017 to May 2019. According to the surgical method, it was divided into percutaneous pedicle screw combined with unilateral nail placement combined with unilateral bone cement strengthening group(bone cement group) and percutaneous pedicle screw combined with bilateral nail placement(screw group). In the bone cement group, 40 patients included 16 males and 24 females, with a mean age of (62.1±8.1) years old. In the screw group, 38 patients included 18 males and 20 females with a mean age of (65.1±9.3) years old. The operation time, intraoperative blood loss, length of hospital stay and postoperative complications were compared between two groups. The kyphosis Cobb angle, anterior edge height ratio, central height ratio and pain visual analogue score(VAS) were compared. RESULTS: All patients were followed up for 25 to 36 months. The operation time (70.1±17.3) min of the cement group was shorter than that of the screw group (78.6±18.2) min(P<0.05). There were no significant differences in intraoperative blood loss and length of hospital stay(P>0.05). The VAS in the cement group 1 year 1.5±0.5 and the latest follow-up 0.5±0.3 after operation were lower than 1 year 1.8±0.3 and the latest follow-up 0.8±0.4 in the screw group(P<0.05). The kyphosis Cobb angle, anterior edge height ratio, central height ratio in bone cement group, 1 year (6.2±1.2)°, (86.6±3.5)%, (91.1±2.5)%, the last follow-up (6.4±0.7)°, (85.5±3.3)%, (90.5±6.3)% were better than that of the screw group 1 year (6.8±1.4)°, (83.1±2.4)%, (89.9±3.4)% and the latest follow-up (7.1±1.1)°, (82.6±4.1)%, (87.6±5.9)%(P<0.05). There were 3 cases of bone cement leakage in the cement group, all of which had no clinical symptoms;and 2 cases of pedicle screws were extracted in the screw group, and the screws were removed at the last follow-up. CONCLUSION Percutaneous pedicle screw combined with unilateral nail placement combined with bone cement strengthening and bilateral nail placement in the treatment of osteoporotic thoracic and lumbar compression fractures in the elderly can achieve satisfactory efficacy and effectively relieve the pain of patients, but the former internal fixation system is more stable, and the long-term follow-up can effectively maintain the height of the anterior middle column and the correction of kyphosis deformity, and the incidence of chronic low back pain is lower.
Humans ; Male ; Female ; Aged ; Bone Cements ; Middle Aged ; Thoracic Vertebrae/surgery* ; Lumbar Vertebrae/surgery* ; Retrospective Studies ; Spinal Fractures/surgery* ; Osteoporotic Fractures/surgery* ; Case-Control Studies ; Bone Nails ; Pedicle Screws

OBJECTIVE: To explore early clinical efficacy and advantages of Huoxue Fang's directional dialysis combined with extracorporeal shock wave in treating rotator cuff injury. METHODS: A retrospective analysis was performed for 42 patients with rotator cuff injury admitted from September 2020 to December 2022, and they were divided into shock wave group and directed dialysis group according to different treatment methods. There were 20 patients in shock wave group, including 12 males and 8 females; aged from 47 to 68 years old with an average of (63.2±3.3) years old;the course of disease ranged from 2 to 6 weeks with an average of (3.1±1.4) weeks;10 patients with gradeⅠand 10 patients with gradeⅡaccording to Ellman classification;non-steroidal drugs and extracorporeal shock wave therapy were performed. There were 22 patients in directed dialysis group, including 16 males and 6 females;aged from 44 to 67 years old with an average of (61.0±2.3) years old;the course of disease ranged from 2 to 8 weeks with average of (3.3±1.3) weeks;12 patients with gradeⅠand 10 patients with gradeⅡaccording to Ellman classification;with Huoxue prescription directed transdrug therapy based on shock wave group. Visual analogue scale (VAS), University of California at Los Angeles (UCLA) and range of motion (ROM) were compared between two groups before treatment, 1 and 6 months after treatment;changes of tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6) between two groups were detected and compared. The complications between two groups were compared. RESULTS: All patients were followed up, shockwave group followed up for 6 to 8 months with an average of (7.1±1.9) months, 6 to 8 months with an average of (7.2±1.8) months in directed dialysis group, with no statistical significance between two groups (P>0.05). At 1 and 6 months after treatment, VAS in directed dialysis group were (3.85±0.99), (1.24±0.75), which were lower than that in shock wave group (4.91±0.89), (1.81±0.84) (P<0.05). UCLA scores in directed dialysis group (25.25±2.34), (32.71±2.33) were higher than those in shock wave group (21.67±3.38) °, (29.11±3.01) °(P<0.05). Forward bending (139.15±20.39) °, (150.14±20.55) °, external rotation (63.46±16.62) °, (73.35±13.82) °, internal rotation (46.99±2.93) °, (58.24±2.10) ° in directed dialysis group were better than those in shock wave group (130.61±22.27) °, (141.28±19.47) °, external rotation (57.36±17.53) °, (68.12±13.64) °, internal rotation (41.21±3.10) °, (49.16±3.21) ° (P<0.05). At 1 and 6 months after treatment, TNF-α, IL-1 and IL-6 in directed dialysis group were (2.12±0.49), (2.06±0.55), (0.69±0.26) μg·L-1;(1.27±0.25), (1.14±0.23), (0.37±0.11) μg·L-1, which were lower than those in shock wave group (2.87±0. 51), (2.67±0.48), (0.92±0.21) μg·L-1, (1.88 ± 0.26), (1.36±0.27), (0.45±0.09) μg·L-1(P<0.05). At the latest follow-up, 8 patients got excellent result, 10 good and 2 poor in shock wave group;10 patients excellent, 10 good, and 2 poor in directed dialysis group;there was no significant difference between two groups (P>0.05). There were no complications such as skin allergy, subcutaneous hemorrhage, ecchymosis, vascular and nerve injury occurred in both groups. CONCLUSION For the treatment of rotator cuff injury, Huoxue prescription combined with extracorporeal shock wave is effective, which could not only release the local adhesion tissue, improve local blood circulation, accelerate absorption of inflammatory exudate of the local soft tissue, and promote recovery of the diseased muscle bond and ligament. It could also effectively relieve shoulder pain, improve shoulder motion, restore shoulder function, improve patients' quality of life.
Humans ; Male ; Female ; Middle Aged ; Aged ; Extracorporeal Shockwave Therapy ; Retrospective Studies ; Rotator Cuff Injuries/physiopathology* ; Adult ; Drugs, Chinese Herbal/administration & dosage* ; Combined Modality Therapy ; Interleukin-6/metabolism*

OBJECTIVE: To investigate the early clinical efficacy of single-position O-arm navigation-assisted oblique lateral interbody fusion(OLIF) combined with minimally invasive percutaneous pedicle screw fixation(PPS) in the treatment of lumbar spondylolisthesis. METHODS: A retrospective analysis was conducted on 22 patients with lumbar spondylolisthesis who underwent OLIF-PPS surgery including 11 males and 11 females with a mean age of (64.6±1.5) years old ranging from 49 to 80 years old between April 2021 and June 2023. All patients presented with lumbosacral pain, lower limb radiating pain, numbness, and had poor responses to conservative treatment. Surgical time, intraoperative blood loss, hospital stay, and postoperative complications were recorded. Clinical outcomes were evaluated using the visual analogue scale(VAS) and Oswestry disability index(ODI) preoperatively at 3 days after operation and the final follow-up. Standing lumbar anteroposterior and lateral X-rays were performed to measure disc height(DH), slippage degree, vertebral reduction rate, pedicle screw accuracy, and cage subsidence. RESULTS: All surgeries were successfully completed with a mean follow-up of (27.1±2.2) months (range 18 to 36 months). The mean surgical time was (76.1±12.2) min (range 60 to 93 min), intraoperative blood loss was (86.3±32.2) ml (range 40 to 113 ml), and hospital stay was (7.1±1.2) days. Postoperative VAS significantly improved from (7.2±0.7) preoperatively to (2.3±0.5) at 3 days after operation and (1.7±0.2) at the final follow-up (P<0.05). ODI decreased from (68.5±7.2)% preoperatively to (30.3±3.1)% at 3 days after operation and (16.6±1.6)% at the final follow-up (P<0.05). DH increased from (8.5±1.7) mm preoperatively to (18.1±1.4) mm at 3 days after operation and (17.2±1.1) mm at the final follow-up (P<0.05). Slippage degree improved from (24.1±4.6)% preoperatively to (10.3±4.2)% at 3 days after operation and (10.1±3.2)% at the final follow-up (P<0.05). A total of 88 pedicle screws were implanted with an excellent rate of 98% (86/88). Complications included transient left hip flexion weakness (2 cases) and left anteromedial thigh pain (1 case), all resolved during follow-up. No incision hematoma, infection, screw loosening, or cage subsidence occurred. CONCLUSION Single-position O-arm navigation-assisted OLIF combined with PPS demonstrates satisfactory early clinical efficacy for lumbar spondylolisthesis, with advantages including minimal invasiveness, significant pain relief, effective vertebral reduction, and low complication rates.
Humans ; Male ; Female ; Spondylolisthesis/diagnostic imaging* ; Middle Aged ; Aged ; Spinal Fusion/methods* ; Lumbar Vertebrae/diagnostic imaging* ; Minimally Invasive Surgical Procedures/methods* ; Pedicle Screws ; Aged, 80 and over ; Retrospective Studies

OBJECTIVE: To explore the efficacy and safety of human epidermal growth factor gel in the treatment of pin tract infections after surgery in patients with severe spinal deformity. METHODS: A retrospective case-control study was conducted to analyze the clinical data of 26 patients with pin tract infections after skull-pelvic ring traction for severe spinal deformity admitted from February 2019 to May 2022. Among them, 11 were male and 15 were female;the age ranged from 18 to 31 years, with an average of (24.1±4.3) years;the Cobb angle ranged 80.3° to 120.7°, with an average of (88.6±10.2)°;there were 52 iliac traction pins, 104 pin tract openings, and 38 pin tract infections. According to the Checketts-Otterbum classification, there were 11 infections of gradeⅠ, 13 infections of gradeⅡ, 10 infections of grade Ⅲ, and 4 infections of grade Ⅳ. The patients were divided into the conventional dressing change group (13 cases) and the growth factor group (13 cases) by coin flipping. Clinical efficacy was evaluated by recording the visual analogue scale(VAS) score during dressing change, duration of dressing change, cost of dressing change, positive rate of bacterial culture, wound improvement rate, and wound improvement time. RESULTS: There were no statistically significant differences in VAS or duration of dressing change between the two groups (P>0.05). The cost of dressing change was (800.0±59.5) yuan in the conventional dressing change group and (1 179.5±80.9) yuan in the growth factor group, with a statistically significant difference (P<0.05). There was no statistically significant difference in the positive rate of bacterial culture between the two groups (P>0.05). In the conventional dressing change group, within 20 pin tract infections, 2 infections achieved wound healing, 7 infections showed improvement, and 11 infections were ineffective;in the growth factor group, within 18 pin tract infections 5 infections achieved wound healing, 8 infections showed improvement, and 5 infections were ineffective, with a statistically significant difference between the two groups (P<0.05). The wound healing time was (22.8±4.9) days in the conventional dressing change group and (14.2±2.5) days in the growth factor group, with a statistically significant difference (P<0.05). No complications occurred in either group. CONCLUSION The application of human epidermal growth factor gel in the treatment of pin tract infections after skull-pelvic ring surgery in patients with severe spinal deformity is easy to operate, does not increase patient pain, and has significant efficacy. It shortens wound healing time, effectively promotes wound healing, and has good safety and high cost-effectiveness.
Humans ; Male ; Female ; Adult ; Adolescent ; Retrospective Studies ; Case-Control Studies ; Young Adult ; Epidermal Growth Factor/therapeutic use* ; Traction/adverse effects* ; Gels ; Bone Nails/adverse effects* ; Surgical Wound Infection/drug therapy*

At present,the development of enhanced recovery after surgery(ERAS)pathways in deep inferior epigastric perforator(DIEP)flap breast reconstruction is still in the initial stage worldwide,lacking established guidelines.In the multidisciplinary ERAS pathways,the department of anesthesiology is responsible for some core elements such as optimizing anestheticprotocols,perioperative fluid management and homeostasis regulation,prevention of hypothermia,improvement of perioperative analgesia,and postoperative nausea and vomiting prophylaxis.We summarized the anesthetic management in the ERAS pathways for patients undergoing DIEP flap breast reconstruction in Fudan University Shanghai Cancer Center,along with the recent progress,aiming to establish and improve the perioperative strategy based on ERAS pathways in DIEP flap breast reconstruction.

Objective To study the application of the trinity model and trinity forecasting method in predicting the incidence trend of pulmonary tuberculosis(PTB).Methods By applying the monthly PTB incidence data in Zhe-jiang Province from 2011 to 2021,a prediction model was constructed based on the trinity model and trinity forecas-ting method.Predictive performance of the model was evaluated.Results The mean relative prediction errors of model 1 and model 2 based on trinity model and trinity forecasting method were 7.94％and 8.43％,respectively.The mean relative prediction error obtained by adopting autoregressive integrated moving average(ARIMA)model was 8.87％,and the above mean relative prediction error were all in the range of 7.9％-8.9％,which presented an excellent performance of the forecasting model.Conclusion The trinity model is an excellent time series forecasting model,and the trinity forecasting method is an excellent time series forecasting method,with high application value.

Objective To evaluate the pharmacokinetics and pharmacodynamics of benzbromarone in patients with hyperuricemia(HUA).Methods Thirty patients with HUA were randomly divided into A,B and C groups,with 10 patients in each group.Three groups was given a single oral dose of benzbromarone 25,50 and 100 mg.After the single administration test,group B continued to take benzbromarone 50 mg orally once a day for 28 days.The concentration of benzbromarone in plasma was measured using liquid chromatography tandem mass spectrometry(LC-MS/MS)method,and the serum uric acid(SUA)level was measured by fully automated biochemical analyzer.Results The single oral administration of benzbromarone tablets exhibited linear pharmacokinetic characteristics within the range of 25-100 mg.The main pharmacokinetic parameters were as follows:t1/2 were(11.67±1.85),(12.84±1.22)and(13.25±1.02)h;tmax values were(2.84±0.15),(3.07±0.18)and(3.15±0.25)h;Cmax values were(2.21±0.85),(2.67±0.68)and(3.25±0.72)mg·L-1;AUC0-24h were(14.25±3.25),(18.20±3.34)and(19.25±3.44)mg·h·L-1,respectively.After continuous administration,there was no significant change in the degree and speed of drug absorption,and there was accumulation in the body.After 28 days of oral treatment with benzbromarone,the SUA levels of 10 HUA patients were significantly reduced,with 8 patients having SUA levels＜360 μmol·L-1.Conclusion A single oral dose of benzbromarone tablets exhibits linear pharmacokinetic characteristics at 25-100 mg,and continuous oral doses of benzbromarone tablets can significantly reduce SUA levels in patients with HUA.

OBJECTIVE To identify, synthesize and analyze the structure of unknown impurities unique to bromhexine hydrochloride injection and set the impurities as known impurity to control. METHODS The structure of unknown impurities was derived through two-dimensional liquid chromatography tandem mass spectrometry(2DLC-HRMS/MS), and the source of impurities was derived based on the product's prescription process. The mechanism of impurities generation was analyzed, and impurity monomers were obtained through directional synthesis. The structure of impurities was confirmed using techniques such as 2DLC-HRMS/MS and nuclear magnetic resonance. Finally, HPLC was used to verify the analysis method of impurities. RESULTS It was confirmed that such impurities were produced in a reaction between bromhexine and the excipient glucose. The correction factor of the two impurities were 2.2 and 2.4, the analytical method was specific and reproducible. CONCLUSION Name the two injection specific impurities as impurity 1 and impurity 2 respectively, and use them as known impurities to be included in the standard, calculate the impurity content using the self control and correction factor method. This study is of great significance in guiding the impurity control of bromhexine hydrochloride injection and the screening of excipient glucose.

Objective:To discuss the effect of Fuzheng Ruanjian Anticancer Formula on the malignant biological behaviors of the hepatocellular carcinoma HepG2 cells by requlating protein kinase B(Akt)/murine double minute 2(MDM2)/P53 signaling pathway.Methods:The HepG2 cells were treated with 0,0.05,0.10,0.20,0.40,0.80,1.60,3.20,and 6.40 g·mL-1 Fuzheng Ruanjian Anticancer Formula for 48 h.CCK-8 method was used to detect the survival rates of the HepG2 cells in various groups,and the concentrations of Fuzheng Ruanjian Anticancer Formula for the subsequent experiments were screened.The HepG2 cells were divided into control group,low dose of Fuzheng Ruanjian Anticancer Formula group(0.2 g·mL-1),medium dose of Fuzheng Ruanjian Anticancer Formula group(0.4 g·mL-1),high dose of Fuzheng Ruanjian Anticancer Formula group(0.8 g·mL-1),SC79 group(8 mg·L-1 SC79),and high dose of Fuzheng Ruanjian Anticancer Formula+SC79 group(0.8 g·mL-1 Fuzheng Ruijian Anticancer Formula+8 mg·L-1 SC79).CCK-8 method was used to detect the proliferation activities of the HepG2 cells in various groups;clone formation assay was used to detect the clone formation rates of the HepG2 cells in various groups;flow cytometry was used to detect the apoptotic rates of the HepG2 cells in various groups;Transwell chamber assay was used to detect the numbers of migration and invasion HepG2 cells in various groups;Western blotting method was used to detect the expression levels of proliferating cell nuclear antigen(PCNA),cysteine aspartate specific proteinase(Caspase-3),matrix metalloproteinase(MMP)-2,MMP-9,phosphorylated Akt(p-Akt),phosphorylated MDM2(p-MDM2),and P53 proteins in the HepG2 cells in various groups.Results:As the increasing of concentrations of Fuzheng Ruanjian Anticancer Formula(0,0.05,0.10,0.20,0.40,0.80,1.60,3.20,and 6.40 g·mL-1),the surival rates of the HepG2 cells were gradually decreased(P<0.05),and 0.2,0.4,and 0.8 g·mL-1 Fuzheng Ruanjian Anticancer Formula were selected for the subsequent experiments.The CCK-8 assay results showed that compared with control group,the proliferation activities of the HepG2 cells in low,medium,and high doses of Fuzheng Ruanjian Anticancer Formula groups were significantly decreased(P<0.05),in a dose-dependent manner,while the proliferation activity of the cells in SC79 group was significantly increased(P<0.05).Compared with high dose of Fuzheng Ruanjian Anticancer Formula group,the proliferation activity of the HepG2 cells in high dose of Fuzheng Ruanjian Anticancer Formula+SC79 group was significantly increased(P<0.05).The clone formation assay results showed that compared with control group,the clone formation rates of the HepG2 cells in low,medium,and high doses of Fuzheng Ruanjian Anticancer Formula groups were significantly decreased(P<0.05)in a dose-dependent manner,while the clone formation rate of the cells in SC79 group was significantly increased(P<0.05);compared with high dose of Fuzheng Ruanjian Anticancer Formula group,the clone formation rate of the cells in high dose of Fuzheng Ruanjian Anticancer Formula+SC79 group was significantly increased(P<0.05).The flow cytometry results showed that compared with control group,the apoptotic rates of the HepG2 cells in low,medium,and high doses of Fuzheng Ruijian Anticancer Formula groups were significantly increased(P<0.05)in a dose-dependent manner,while the apoptotic rate of the cells in SC79 group was significantly decreased(P<0.05);compared with high dose of Fuzheng Ruanjian Anticancer Formula group,the apoptotic rate of the cells in high dose of Fuzheng Ruanjian Anticancer Formula+SC79 group was significantly decreased(P<0.05).The Transwell chamber assay results showed that compared with control group,the numbers of migration and invasion HepG2 cells in low,medium,and high doses of Fuzheng Ruanjian Anticancer Formula groups were significantly decreased(P<0.05)in a dose-dependent manner,while the numbers of migration and invasion cells in SC79 group were significantly increased(P<0.05);compared with high dose of Fuzheng Ruanjian Anticancer Formula group,the numbers of migration and invasion HepG2 cells in high dose of Fuzheng Ruanjian Anticancer Formula+SC79 group were significantly increased(P<0.05).The Western blotting results showed that compared with control group,the expression levels of PCNA,MMP-2,MMP-9,p-Akt,and p-MDM2 proteins in the cells in low,medium,and high doses of Fuzheng Ruanjian Anticancer Formula groups were significantly decreased(P<0.05)in a dose-dependent manner,while the expression levels of Caspase-3 and P53 proteins were significantly increased(P<0.05)in a dose-dependent manner,while the expression levels of PCNA,MMP-2,MMP-9,p-Akt,and p-MDM2 proteins in the cells in SC79 group were significantly increased(P<0.05),and the expression levels of Caspase-3 and P53 proteins were significantly decreased(P<0.05);compared with high dose of Fuzheng Ruanjian Anticancer Formula group,the expression levels of PCNA,MMP-2,MMP-9,p-Akt,and p-MDM2 proteins in the cells in high dose of Fuzheng Ruanjian Anticancer Formula+SC79 group were significantly increased(P<0.05),while the expression levels of Caspase-3 and P53 proteins were significantly decreased(P<0.05).Conclusion:Fuzheng Ruanjian Anticancer Formula may inhibit the proliferation,migration,and invasion of the HepG2 cells and promote the apoptosis,and its mechanism may be related to suppressing the Akt/MDM2 signaling pathway and upregulating the P53 proteim expression.