Objective To explore the effects of different grinding amounts of articular processes on the biomechanical stability and inflammatory response of lumbar spine during percutaneous foraminoscopic surgery(PTED).Methods A total of 195 patients with lumbar disc herniation(LDH)in our hospital were selected for prospective study from January 2018 to October 2020,and they were divided into three groups by randomized numerical table method,each with 65 cases,and all of them were implemented PTED.Patients with intraoperative upper joint process grinding＜33％were treated as a small group,patients with intraoperative grinding＜33％～50％were treated as a medium group,and patients with＞50％were treated as a large group.The surgery-related indexes of the three groups of patients were observed,as well as the inflammatory indexes[interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],biomechanical stability,and joint functional recovery scores at different time points before and after surgery.Results The operation time and intraoperative bleeding were(61.32±7.86)min and(11.85±1.10)ml in the small group,(70.06±8.53)min and(14.32±2.21)ml in the medium group,and(74.47±10.00)min and(19.86±3.00)ml in the large group,and the differences among the three groups were statistically significant(P＜0.05).Serum IL-6 and TNF-α were(6.10±1.12)pg/ml and(8.21±1.87)ng/L in the small group 3d postoperatively,and(3.27±0.58)pg/ml and(4.32±1.00)ng/L in the discharge group,and in the medium group 3d postoperatively,they were(6.68±1.35)pg/ml and(9.00±1.20)ng/L at discharge and(4.10±0.63)pg/ml and(6.85±1.28)ng/L at discharge,respectively,and(7.32±1.00)pg/ml and(10.57±1.28)ng/L in the massive group at 3d postoperatively and(4.57±0.49)pg/ml and(8.14±1.35)ng/L at discharge,and the difference between the three groups was statistically significant(P＜0.05);the serum lumbar lordosis angle,lumbar flexion,and lumbar stability scores were(42.28±2.12)°,(1.86±0.36)cm,and(10.52±2.01)° at 1 month postoperatively,and(42.11±1.97)°,(1.87±0.52)cm,and(10.63±1.96)° at 1 year postoperatively,respectively,for the small group,and(40.86±1.89)°,(1.72±0.28)cm,(10.63±2.15)scores,(39.15±2.11)°,(1.60±0.42)cm,(12.11±1.63)scores for the medium group,respectively,1 month postoperatively in the large volume group,(39.01±2.35)°,(1.61±0.29)cm,(11.20±2.75)scores,and(38.11±2.32)°,(1.43±0.33)cm,(13.24±1.52)scores at 1 year postoperatively,respectively,and the difference between the three groups were statistically significant(P＜0.05).Conclusion PTED treatment of LDH can reduce the amount of grinding of the superior articular process during surgery,reduce operative time and intraoperative bleeding,alleviate inflammatory response,and achieve good short-and medium-term lumbar function and joint stability.

Objective To explore the effects of different grinding amounts of articular processes on the biomechanical stability and inflammatory response of lumbar spine during percutaneous foraminoscopic surgery(PTED).Methods A total of 195 patients with lumbar disc herniation(LDH)in our hospital were selected for prospective study from January 2018 to October 2020,and they were divided into three groups by randomized numerical table method,each with 65 cases,and all of them were implemented PTED.Patients with intraoperative upper joint process grinding＜33％were treated as a small group,patients with intraoperative grinding＜33％～50％were treated as a medium group,and patients with＞50％were treated as a large group.The surgery-related indexes of the three groups of patients were observed,as well as the inflammatory indexes[interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],biomechanical stability,and joint functional recovery scores at different time points before and after surgery.Results The operation time and intraoperative bleeding were(61.32±7.86)min and(11.85±1.10)ml in the small group,(70.06±8.53)min and(14.32±2.21)ml in the medium group,and(74.47±10.00)min and(19.86±3.00)ml in the large group,and the differences among the three groups were statistically significant(P＜0.05).Serum IL-6 and TNF-α were(6.10±1.12)pg/ml and(8.21±1.87)ng/L in the small group 3d postoperatively,and(3.27±0.58)pg/ml and(4.32±1.00)ng/L in the discharge group,and in the medium group 3d postoperatively,they were(6.68±1.35)pg/ml and(9.00±1.20)ng/L at discharge and(4.10±0.63)pg/ml and(6.85±1.28)ng/L at discharge,respectively,and(7.32±1.00)pg/ml and(10.57±1.28)ng/L in the massive group at 3d postoperatively and(4.57±0.49)pg/ml and(8.14±1.35)ng/L at discharge,and the difference between the three groups was statistically significant(P＜0.05);the serum lumbar lordosis angle,lumbar flexion,and lumbar stability scores were(42.28±2.12)°,(1.86±0.36)cm,and(10.52±2.01)° at 1 month postoperatively,and(42.11±1.97)°,(1.87±0.52)cm,and(10.63±1.96)° at 1 year postoperatively,respectively,for the small group,and(40.86±1.89)°,(1.72±0.28)cm,(10.63±2.15)scores,(39.15±2.11)°,(1.60±0.42)cm,(12.11±1.63)scores for the medium group,respectively,1 month postoperatively in the large volume group,(39.01±2.35)°,(1.61±0.29)cm,(11.20±2.75)scores,and(38.11±2.32)°,(1.43±0.33)cm,(13.24±1.52)scores at 1 year postoperatively,respectively,and the difference between the three groups were statistically significant(P＜0.05).Conclusion PTED treatment of LDH can reduce the amount of grinding of the superior articular process during surgery,reduce operative time and intraoperative bleeding,alleviate inflammatory response,and achieve good short-and medium-term lumbar function and joint stability.

To develop a medication reminder based on Android platform, which can be used to set up personalized reminders quickly and record the patient' s medication time-stamp and related information. In addition, the effect of using the reminder on medication compliance was studied. 14 subjects participated in the evaluation of medica-tion compliance. The differences of dosage and medication rate between the group using and without using reminder were investigated. The dosage and medication rate were got by the pill counting. The Wilcoxon matched -pairs signed rank test showed that the dosage and the medication rate of the group using reminder were higher than that without using reminder significantly(Z= -2. 93, P =0. 003 ). The results demonstrated that the use of the re-minder can improve the medication dose and rate significantly,indicate that the reminder might be a new technical support for clinical research on medication compliance, and also might reduce the workload for medical staff and patients.

Objective To research the effect of pure interbody fusion and interbody cage fusion under minimally invasive transforaminal lumbar interbody fusion treat to single segment of lumbar disc herniation,analysis clinical value the two methods.Methods A total of 61 cases single segment lumbar disc herniation were treated with MIS-TLIF surgery,were divided into pure interbody fusion group (group A) and interbody fusion Cage group (group B) according to different fusion methods.Operative time,blood loss and postoperative drainage were recorded in two groups,the clinical efficacy were tested by using of visual analogue score (VAS),Japanese Orthopedic Association scores (JOA),Oswestry disability index (ODI) score and Macnab standard,the interbody fusion ability were evaluated by power lumbar X-ray film and CT 3D reconstruction.Results The gender,age,disease duration and disease segments in two gracps were not found statistically significant difference (P＞0.05).Also,two groups of patients,blood loss,postoperative drainage has no significant difference (P＞0.05).After the operation,the VAS score,ODI score,JOA score and Macnab criteria,the last follow-up of intervertebral fusion rate in in tuo groups were not found statistically significant difference (P＞0.05).While the operative time,postoperative disc height changes were found significant difference between two groups (P＜ 0.05).Conclusion MIS-TLIF simple fusion for lumbar disc herniation will be available with equal clinical efficacy fusion rate compared with cage fusion.

AIM:This study continuously monitors the hemodynamic changes in conscious and anesthetic rats during rapid ascent to high altitude to investigate whether there is difference between the 2 conditions and discuss the rela-ted underlying mechanism.METHODS: Sprague-Dawley rats were randomly divided into conscious group, anesthetic group, anesthetic-5000-control ( A-5000-control) group, anesthetic-5000-aminoguanidine ( A-5000-AG) group, conscious-5000-control ( C-5000-control ) group and conscious-5000-aminoguanidine ( C-5000-AG ) group.The rats in anesthetic group and conscious group were kept in a hypobaric chamber, in which the simulated altitude was increased from 2 260 m to 5 000 m at 2 m/s, and the rats in other 4 groups were at 5 000 m.The system arterial pressure ( Psa) , central venous pressure ( CVP) , heart rate ( HR) and breathing rate ( BR) were directly and continuously displayed and digitally recorded by a high-performance data acquisition (PowerLab 16/35, AD Instruments) at 200 Hz.RESULTS: The HR and BR in the conscious rats were higher and MAP was lower than those in the anesthetic rats obviously.A significant decrease in mean arterial pressure ( MAP) in conscious and anesthetic groups was observed following the increase in the altitude levels, and the net decrease in MAP in conscious group was significantly greater.Additionally, HR in the conscious rats was sig-nificantly lower at 5 000 m than that of the initial level.The rats in C-5000-AG group and A-5000-AG group showed a sig-nificant increase in the arterial pressure after the intravenous injection of AG, a selective inhibitor of inducible nitric oxide synthase ( iNOS) , and no marked change of HR and BR was found.CONCLUSION: Blood pressure and HR decrease during rapid ascent to high altitude, while the change of BR is not obvious.The mechanisms of self-safety would be trig-gered in the early stage of hypoxia, which activates iNOS and then leads to a larger number of nitric oxide.Plentiful NO di-astolizes the vessels to improve the ventilation-perfusion mismatch and lower the blood pressure.When the altitude arise to 5 000 m, even more earlier, a decompensatory stage may occur in the body, leading to decreased HR and blood pressure further more than those in the anesthetic rats.Due to the effects of pentobarbital sodium, the depression of blood pressure requires a lag period and the net decrease in MAP is less than that in the conscious rats.Therefore, hemodynamic changes during rapid ascent to high altitude in conscious rats are more comprehensive and authentic.

BACKGROUNDThoracic endovascular aortic repair (TEVAR) is an emerging treatment modality, which has been rapidly embraced by clinicians treating thoracic aortic disease. However, the clinical manifestations of systemic inflammatory response after TEVAR as post-implantation syndrome (PIS) resemble the perioperative infection. This study aimed to evaluate changes and diagnostic value of procalcitonin (PCT) and other traditional inflammatory markers for infections after TEVAR.

METHODSWe conducted a prospective clinical study that enrolled 162 consecutive aortic dissection cases, who underwent TEVAR in our institution between July 2011 and November 2012. The PCT, C-response protein (CRP), erythrocyte sedimentation rate (ESR) and blood routine examination were monitored before the operation and on days 1, 2, 3 and 5 after the operation. The diagnosis of infection was confirmed by the infection control committee with reference to Hospital Acquired Infection Diagnostic Criteria Assessment, released by the Ministry of Health of the People's Republic of China.

RESULTSPost endovascular repair of thoracic aorta, PCT changes significantly at different time points (χ(2) = 13.225, P = 0.021), without significant difference between the PIS group and the control group (0.24 ± 0.04 vs.0.26 ± 0.10, P = 0.804). PCT values were significantly higher in the first day after TEVAR than the preoperative levels (0.18 ± 0.03 vs. 0.11 ± 0.02, P < 0.001). Compared with PIS patients, the level of PCT, CRP, White blood cell (WBC) and neutrophil (NEU) in the infection patients elevated significantly (relatively χ(2) = 6.062, P = 0.048; χ(2) = 6.081, P = 0.048; χ(2) = 11.030, P = 0.004; χ(2) = 14.632, P = 0.001). According to the ROC analysis, the PCT levels in the first day after TEVAR (AUC = 0.785, P = 0.012) had better predictive values of infection than WBC, NEU CRP and ESR (AUC = 0.720, P = 0.040; AUC = 0.715, P = 0.045; AUC = 0.663, P = 0.274; AUC = 0.502, P = 0.991). The best predictive index was the changes of PCT between preoperative and postoperative (PCT), which possess AUC as 0.803 (P = 0.014). And PCT = 0.055 could be considered as an infection diagnosis cutoff value with a sensitivity of 83.3% and specificity 69.0%.

CONCLUSIONSPCT provides better diagnostic value of infection compared with other inflammatory markers. The potential applications of PCT in differential diagnosis of PIS and infection after percutaneous TEVAR deserve further studies.

Adult ; Aged ; Blood Sedimentation ; C-Reactive Protein ; metabolism ; Calcitonin ; metabolism ; Calcitonin Gene-Related Peptide ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Protein Precursors ; metabolism ; Vascular Surgical Procedures

Objective To evaluate the safety and accuracy in treating the avascular necrosis of femoral head (ANFH) with computer navigated core decompression and bone marrow stream cell transportation and to guide the clinical treatment. Method Within the prospective study, 36 patients suffered ANFH (ARCO Ⅰ - Ⅱ ) and treated with computer navigated core decompression and bone marrow stream cell transportation were studied. The operating time, blood loss, x ray exposure, preoperative and 6 week postoperative Harris score and imaging evaluation were recorded and compared with conventional core decompression and bone marrow stream cell transportation. Results There were no obvious difference between the two groups in imaging evaluation, operating time and blood loss ( P ＞ 0. 05 ). There were statistical difference between the two groups in x ray exposure and 6 week postoperative Harris score [ (4. 1 ± 1.8 ) s,(13.6±3.2)s,P ＜0. 01,and89.4±10. 1,83.1±10. 5, P ＜0.01]. Conclusion Computer navigated core decompression and bone marrow stream cell transportation have good security and precision in treating early stage ANFH.