Objectives:To compare the differences in three rat intervertebral disc degeneration(IDD)models constructed by needle injections of ethanol into the nucleus pulposus,annulus fibrosus,and endplate,respectively.Methods:45 6-week-old Sprague-Dawley rats were randomly divided into three groups using a random number table method,with 15 rats in each group.Three different needle injection of ethanol methods including nucleus pulposus injection(nucleus pulposus injection group),annulus fibrosus injection(annulus fibrosus injection group),and endplate injection(endplate injection group)were used to construct IDD models at the Co6/7 intervertebral disc in rats.At 1,2,3,and 4 weeks post-modeling,3 rats from each group were randomly selected using a random number table for X-ray examination to measure and calculate the disc height index(DHI)of the Co6/7 in rats.Subsequently,rats were euthanized under excessive anesthesia,and the Co6/7 intervertebral disc along with adjacent vertebral bodies were harvested for hematoxylin-eosin(HE)staining to observe degeneration,and the degeneration degree was histologically scored.Results:One rat in each of the nucleus pulposus injection group and annulus fibrosus injection group died unexpectedly due to anesthesia;In the endplate injection group,two rats died due to postoperative infection.At 1,2,3,and 4 weeks after modeling,3 rats were selected from each group of the remaining rats,and a total of 36 rats were included in the result analysis.The remaining rats were sacrificed by excessive anesthesia.One week after modeling,the Co6/7 DHI in each group was lower than that before modeling(Nucleus pulposus injection group:0.117±0.002 vs 0.134±0.005;Annulus fibrosus injection group:0.126±0.005 vs 0.133±0.005;Endplate injection group:0.127±0.002 vs 0.130±0.007,all P＜0.05),which gradually decreased over time.After modeling in each group,the annulus fibrosus broke,the arrangement of fibers gradually became disordered,the matrix and cells of the nucleus pulposus were gradually lost or even completely disappeared,the intervertebral discs gradually collapsed,and the intervertebral spaces gradually narrowed.The degeneration rate and degree of the nucleus pulposus injection group were faster and higher than those of the other two groups.Four weeks after modeling,the DHI of the nucleus pulposus injection group was 0.090±0.008,which was lower than that of the annulus fibrosus injection group(0.106±0.007,P＜0.05)and endplate injection group(0.109±0.000,P＜0.05);The histological score of the nucleus pulposus injection group was 10.00±0.82,which was higher than that of the annulus fibrosus injection group(9.00±1.41,P＜0.05)and endplate injection group(8.75±0.96,P＜0.05).Conclusions:The three needle injection of ethanol methods have their own unique characteristics for constructing IDD models.Nucleus pulposus injection induces the fastest and most severe degeneration,endplate injection leads to slower degeneration but is more in line with natural degeneration processes,and annulus fibrosus injection falls between the other two methods in terms of degeneration characteristics.

Objectives:To compare the differences in three rat intervertebral disc degeneration(IDD)models constructed by needle injections of ethanol into the nucleus pulposus,annulus fibrosus,and endplate,respectively.Methods:45 6-week-old Sprague-Dawley rats were randomly divided into three groups using a random number table method,with 15 rats in each group.Three different needle injection of ethanol methods including nucleus pulposus injection(nucleus pulposus injection group),annulus fibrosus injection(annulus fibrosus injection group),and endplate injection(endplate injection group)were used to construct IDD models at the Co6/7 intervertebral disc in rats.At 1,2,3,and 4 weeks post-modeling,3 rats from each group were randomly selected using a random number table for X-ray examination to measure and calculate the disc height index(DHI)of the Co6/7 in rats.Subsequently,rats were euthanized under excessive anesthesia,and the Co6/7 intervertebral disc along with adjacent vertebral bodies were harvested for hematoxylin-eosin(HE)staining to observe degeneration,and the degeneration degree was histologically scored.Results:One rat in each of the nucleus pulposus injection group and annulus fibrosus injection group died unexpectedly due to anesthesia;In the endplate injection group,two rats died due to postoperative infection.At 1,2,3,and 4 weeks after modeling,3 rats were selected from each group of the remaining rats,and a total of 36 rats were included in the result analysis.The remaining rats were sacrificed by excessive anesthesia.One week after modeling,the Co6/7 DHI in each group was lower than that before modeling(Nucleus pulposus injection group:0.117±0.002 vs 0.134±0.005;Annulus fibrosus injection group:0.126±0.005 vs 0.133±0.005;Endplate injection group:0.127±0.002 vs 0.130±0.007,all P＜0.05),which gradually decreased over time.After modeling in each group,the annulus fibrosus broke,the arrangement of fibers gradually became disordered,the matrix and cells of the nucleus pulposus were gradually lost or even completely disappeared,the intervertebral discs gradually collapsed,and the intervertebral spaces gradually narrowed.The degeneration rate and degree of the nucleus pulposus injection group were faster and higher than those of the other two groups.Four weeks after modeling,the DHI of the nucleus pulposus injection group was 0.090±0.008,which was lower than that of the annulus fibrosus injection group(0.106±0.007,P＜0.05)and endplate injection group(0.109±0.000,P＜0.05);The histological score of the nucleus pulposus injection group was 10.00±0.82,which was higher than that of the annulus fibrosus injection group(9.00±1.41,P＜0.05)and endplate injection group(8.75±0.96,P＜0.05).Conclusions:The three needle injection of ethanol methods have their own unique characteristics for constructing IDD models.Nucleus pulposus injection induces the fastest and most severe degeneration,endplate injection leads to slower degeneration but is more in line with natural degeneration processes,and annulus fibrosus injection falls between the other two methods in terms of degeneration characteristics.

Objective:To compare the efficacy of ultrasound volume navigation (UVN) and that of O-arm navigation in the treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation.Methods:A retrospective study was conducted to analyze the clinical data of 29 patients with thoracolumbar vertebral fracture who had been treated with percutaneous pedicle screw fixation at Department Ⅰ of Minimally Invasive Spinal Surgery, Luoyang Orthopedic Hospital from January 2022 to June 2023. The patients were assigned into 2 groups according to different navigation methods. In group UVN of 17 cases, there were 14 males and 3 females with a mean age of 50.0 (44.0, 53.5) years, and the pedicle screw fixation was guided by UVN; in group O-arm of 12 cases, there were 10 males and 2 females with an age of (40.6±11.1) years, and the pedicle screw fixation was guided by O-arm navigation. The 2 groups were compared in terms of insertion time per screw, total dose of intraoperative radiation, radiation dose per screw, accuracy of screw placement, rate of facet joint violation, and visual analogue scale (VAS) pain scores for lumbar pain at postoperative 1, 3, and 6 months.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). There was no statistically significant difference in the insertion time per screw between group UVN and group O-arm [(13.2±1.3) min versus (14.1±1.3) min] ( P>0.05). The total dose of intraoperative radiation and radiation dose per screw in group UVN [(1.80±0.54) mSv and (0.41±0.10) mSv] were significantly lower than those in group O-arm [(3.52±0.33) mSv and (0.85±0.11) mSv] ( P<0.05). The accuracy of screw placement and rate of facet joint violation in group UVN [94.7% (71/75) and 17.6% (3/17)] were not significantly different from those in group O-arm [92.2% (47/51) and 8.3% (1/12)]] ( P>0.05). The VAS score at postoperative 1 month in group UVN [4.0 (3.5, 5.0) points] was significantly lower than that in group O-arm [5.0 (5.0, 6.0) points] ( P<0.05). There were no statistically significant differences between the 2 groups in the VAS pain scores at postoperative 3 and 6 months ( P>0.05). Conclusions:In the treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation, screw placement guided by UVN is as time-saving, intuitive, and accurate as that guided by O-arm navigation. However, UVN is better than O-arm navigation in radiation avoidance and pain relief.

Objective: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with onset in infancy. Early intervention is critical to improve the prognosis for these children. E-health interventions have tremendous potential. This review aimed to determine the status and effectiveness of family interventions for parents of children aged 0–6 years with ASD in the context of e-health. Methods: The review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, Web of Science, and China National Knowledge Infrastructure were searched from inception to June 2022. The searches were limited to children with ASD of the age range between 0 and 6 years. We collated the available information and used descriptive statistics to analyze the synthesized data. Results: Our initial search identified 3,672 articles, of which 30 studies met the inclusion criteria. The 30 articles selected were released between 2012 and 2022. All articles are in English. Most articles reviewed were from high-income countries (27/30, 90.0%), especially from the United States (16/30, 53.3%). Four major themes emerged from the 30 studies that matched the inclusion criteria, as follows: 1) type of e-health interventions, 2) duration of interventions, 3) clinical aspects of e-health interventions, and 4) evidence for intervention effectiveness, looking into the positive, negative, and mixed findings of previous studies. Conclusion These findings suggest that a wide variety of e-health interventions may actually help support both children with ASD aged 0–6 years and their parents.

Objective:To compare the efficacy of ultrasound volume navigation (UVN) and that of O-arm navigation in the treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation.Methods:A retrospective study was conducted to analyze the clinical data of 29 patients with thoracolumbar vertebral fracture who had been treated with percutaneous pedicle screw fixation at Department Ⅰ of Minimally Invasive Spinal Surgery, Luoyang Orthopedic Hospital from January 2022 to June 2023. The patients were assigned into 2 groups according to different navigation methods. In group UVN of 17 cases, there were 14 males and 3 females with a mean age of 50.0 (44.0, 53.5) years, and the pedicle screw fixation was guided by UVN; in group O-arm of 12 cases, there were 10 males and 2 females with an age of (40.6±11.1) years, and the pedicle screw fixation was guided by O-arm navigation. The 2 groups were compared in terms of insertion time per screw, total dose of intraoperative radiation, radiation dose per screw, accuracy of screw placement, rate of facet joint violation, and visual analogue scale (VAS) pain scores for lumbar pain at postoperative 1, 3, and 6 months.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). There was no statistically significant difference in the insertion time per screw between group UVN and group O-arm [(13.2±1.3) min versus (14.1±1.3) min] ( P>0.05). The total dose of intraoperative radiation and radiation dose per screw in group UVN [(1.80±0.54) mSv and (0.41±0.10) mSv] were significantly lower than those in group O-arm [(3.52±0.33) mSv and (0.85±0.11) mSv] ( P<0.05). The accuracy of screw placement and rate of facet joint violation in group UVN [94.7% (71/75) and 17.6% (3/17)] were not significantly different from those in group O-arm [92.2% (47/51) and 8.3% (1/12)]] ( P>0.05). The VAS score at postoperative 1 month in group UVN [4.0 (3.5, 5.0) points] was significantly lower than that in group O-arm [5.0 (5.0, 6.0) points] ( P<0.05). There were no statistically significant differences between the 2 groups in the VAS pain scores at postoperative 3 and 6 months ( P>0.05). Conclusions:In the treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation, screw placement guided by UVN is as time-saving, intuitive, and accurate as that guided by O-arm navigation. However, UVN is better than O-arm navigation in radiation avoidance and pain relief.

OBJECTIVE: To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study. METHODS: Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T ₁₂ in 15 cases, L ₁ in 20 cases, L ₂ in 19 cases, and L ₃ in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded. RESULTS: In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant ( P<0.05). CONCLUSION UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.
Male ; Female ; Humans ; Middle Aged ; Pedicle Screws ; Prospective Studies ; X-Rays ; Surgery, Computer-Assisted/methods* ; Spinal Fusion/methods* ; Fluoroscopy/methods* ; Lumbar Vertebrae/injuries*

OBJECTIVE: To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. METHODS: Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI. RESULTS: The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI ( r=0.224, P=0.233; r=0.034, P=0.697). CONCLUSION UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.
Humans ; Imaging, Three-Dimensional ; Lumbar Vertebrae/surgery* ; Minimally Invasive Surgical Procedures ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Surgery, Computer-Assisted ; Tomography, X-Ray Computed ; Treatment Outcome

This paper describes how to apply UpToDate ? system can be applied into the evidence-based teaching of difficult and critical clinical problems of nephrology, combined with the practical case of standardized training for specialists. The treatment difficulties can be put forward by teachers or students, and appropriate terms are selected to search in UpToDate ?. The students are required to learn the content of the searched items, and then give their treatment choices and clarify reasons according to the condition of patients. After that, the instructing doctor will comment on the statements of each training specialist, and give treatment plans. Promotion the application of UpToDate ? system is helpful to improve the teaching quality of the standardized training for specialists.

Objective:To compare the prognosis of hemodialysis (HD) and peritoneal dialysis (PD) in end-stage renal disease (ESRD) patients without diabetes mellitus and identify related influencing factors.Methods:Patients who started hemodialysis with an arteriovenous graft or fistula or PD in the First Affiliated Hospital of Zhengzhou University from January 1, 2013 to February 1,2019 were included. They were followed up until May 1, 2019. The patients were divided into HD group and PD group according to the initial dialysis modality. Kaplan-Meier method was used to obtain survival curves, the Cox regression model was used to evaluate influence factors for survival rates, and the inverse probability of treatment weighting (IPTW) was used to eliminate influence of the confounders in the groups.Results:There were 371 patients with maintenance dialysis enrolled in this study, including 113 cases (30.5%) in HD group and 258 cases (69.5%) in PD group. At baseline, the scores of standard mean difference ( SMD) in age, body mass index (BMI), combined with cerebrovascular disease, Charlson comorbidity index (CCI), blood potassium, plasma albumin and hemoglobin between the two groups were greater than 0.1. The score of SMD decreased after IPTW, and the most data were less than 0.1, which meant that the balance had been reached between the two groups. The Kaplan-Meier survival curve showed that the cumulative survival rates had no significant difference for all-cause death before using IPTW between the two groups (Log-rank χ2=0.094, P=0.759). After adjusting for confounders with IPTW, the Kaplan-Meier survival curve showed that the cumulative survival rates still had no significant difference for all-cause death between the two groups (Log-rank χ2=2.090, P=0.150). Univariate Cox regression analysis showed that there was no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus for all-cause death (PD/HD, HR=1.171, 95% CI 0.426-3.223, P=0.760). Multivariate Cox regression analysis showed that there was no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus (PD/HD, HR=1.460, 95% CI 0.515-4.144, P=0.477), and high plasma albumin ( HR=0.893, 95% CI 0.813-0.981, P=0.019) was an independent protective factor for survival in ESRD patients without diabetes mellitus. There was still no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus after using IPTW (PD/HD, HR=1.842, 95% CI 0.514-6.604, P=0.348). Conclusion:The difference of cumulative survival rates between HD and PD is not significant in ESRD patients without diabetes mellitus.

CRISPR-Cas Systems ; Embryo, Mammalian ; Gene Editing ; methods ; HEK293 Cells ; Humans ; Polycomb Repressive Complex 1 ; genetics ; Zygote