1.Exploration on the Effects of Tuina on Glutamate Content and Synaptic Ultrastructure in Spinal Dorsal Horn of Rats with Chronic Sciatic Nerve Compression Injury Based on the SNAP25/VGLUT2 Pathway
Jingjing JIANG ; Limei HUANG ; Hongye HUANG ; Hengchang CAI ; Huanzhen ZHANG ; Lechun CHEN ; Shuijin CHEN ; Shiye WU ; Hui LIN ; Zhigang LIN
Chinese Journal of Information on Traditional Chinese Medicine 2025;32(4):113-119
Objective To observe the effect of tuina on glutamate content and synaptic ultrastructure in spinal dorsal horn of rats with chronic sciatic nerve compression injury;To explore the potential mechanism of tuina regulation of the SNAP25/VGLUT2 pathway in alleviating lumbar disc herniation.Methods A chronic sciatic nerve compression injury model was used to simulate neuropathic pain in lumbar disc herniation.24 SD rats were randomly divided into blank group,model group and tuina group,with 8 rats in each group.From the 4th day after modeling,the tuina group was intervened with the tuina method for 10 minutes once a day for 14 consecutive days.The paw withdrawal threshold(PWT)and paw withdrawal latency(PWL)of rats in each group on the day before modeling,and the 4th,10th,14th and 17th days after modeling were detected.The spinal cord tissue of the modeling side was taken,synaptic ultrastructure of spinal dorsal horn neurons was observed using transmission electron microscopy,immunofluorescence staining was used to detect the expression of NR2A in the spinal dorsal horn,Western blot was used to detect the expression of SNAP25 protein in the spinal dorsal horn,immunohistochemistry was used to detect the expression of VGLUT2 in the spinal dorsal horn,ELISA was used to detect the content of glutamate in the spinal dorsal horn.Results Compared with the blank group,PWT and PWL of the model group were significantly reduced on the 4th,10th,14th and 17th days after modeling(P<0.001),with accumulation of vesicles in the presynaptic membrane of the dorsal horn of the spinal cord,increase in the area of the postsynaptic dense zone,and enlargement of the synaptic cleft,while the protein expressions of NR2A,SNAP25 and VGLUT2 in the spinal dorsal horn increased(P<0.05,P<0.001),and the content of glutamate increased(P<0.001).Compared with the model group,PWT and PWL of the tuina group rats significantly increased on the 10th,14th and 17th days after modeling(P<0.001),synaptic vesicles were evenly distributed,the area of the postsynaptic dense zone decreased,and the synaptic cleft decreased,while the protein expressions of NR2A,SNAP25 and VGLUT2 in the spinal dorsal horn decreased(P<0.05,P<0.001),and the content of glutamate decreased(P<0.01).Conclusion Tuina may regulate the content of glutamate through the SNAP25/VGLUT2 pathway in the spinal dorsal horn,improve the synaptic ultrastructure of neurons,and have an analgesic effect on lumbar disc herniation.
2.Analysis of influencing factors of severe influenza B virus pneumonia complicated with invasive pulmonary aspergillosis
Zhigang ZHAO ; Hui LIU ; Hongmei LIU
Tianjin Medical Journal 2025;53(7):736-740
Objective To investigate the clinical characteristics and risk factors of severe influenza B viral pneumonia complicated with invasive pulmonary aspergillosis.Methods Forty-six patients with severe influenza B virus pneumonia were collected and divided into the invasive pulmonary aspergillosis(IPA)group(17 cases)and the control group(29 cases)based on whether they were complicated with IPA.The clinical manifestations,laboratory indicators,chest CT imaging findings,bronchoscopic manifestations,broncho alveolar lavage fluid(BALF)culture and metagenomic next-generation sequencing results were compared between the two group.Treatment conditions and final treatment outcomes were also compared between the two groups.Univariate and multivariate Logistic regression analyses were conducted to explore risk factors of severe influenza B virus pneumonia complicated with IPA.Results After treatment,a total of 6 patients died(35.30%),all of whom were in the invasive pulmonary aspergillosis group.In both groups,the symptoms of dyspnea,cough,expectoration and chest pain were more severe,and systemic symptoms such as fatigue,fever and muscle pain were also quite obvious.There were no significant differences in clinical symptoms,combined bacterial infection and hormone use between the two groups.Compared with the control group,white blood cell count,neutrophil count,blood GM test and BALF GM test were higher in the combined group.The proportion of patients with nodules and patchy shadows on imaging and the proportion of patients showing pseudomembrane manifestations under bronchoscopy were higher(P<0.05).Univariate Logistic regression analysis showed that white blood cell count,GM in BALF,nodules and patchy shadows in lung imaging and pseudomembrane manifestations under bronchoscopy were influencing factors for severe influenza B virus pneumonia combined with invasive pulmonary aspergillosis(P<0.05).Multivariate Logistic regression analysis showed that GM≥1 in BALF and pseudomembrane manifestations under bronchoscopy were risk factors for severe influenza B virus pneumonia combined with invasive pulmonary aspergillosis(P<0.05).Conclusion When GM test level of BALF in patients with severe influenza B virus pneumonia is≥1 and pseudomembrane manifestations are seen under bronchoscopy,the possibility of combined invasive pulmonary aspergillus infection should be highly vigilant.
3.Seroepidemiological of hepatitis B among outpatients in medical institutions in Jiaxing City
LIU Minqi ; GE Rui ; HOU Zhigang ; MAO Rong ; GAO Hui ; WU Daming ; DAI Linye
Journal of Preventive Medicine 2025;37(12):1272-1276
Objective:
To investigate the seroepidemiological characteristics of hepatitis B among outpatients in medical institutions in Jiaxing City, Zhejiang Province, so as to provide a reference for formulating region-specific hepatitis B prevention and control strategies.
Methods:
From April to June 2024, outpatients were selected as study subjects from sentinel medical institutions in Jiaxing City. Information such as gender and age was collected. Venous blood samples were obtained and serological markers including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), and hepatitis B core antibody (HBcAb) were tested. Positive rates of hepatitis B virus (HBV) serological markers were analyzed by genders and ages.
Results:
A total of 1 468 outpatients were included, among whom 721 were males (49.11%) and 747 were females (50.89%). The mean age was (46.41±19.66) years. The positive rates of HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb were 7.29%, 44.75%, 1.84%, 23.50%, and 42.03%, respectively. The HBcAb positive rate in males was significantly higher than in females (46.05% vs. 38.15%, P<0.05), while no statistically significant gender differences were observed in the positive rates of other four HBV serological markers (all P>0.05). Except for HBsAb, the positive rates of the other four HBV serological markers showed statistically significant differences across different age groups (all P<0.05). Pairwise comparisons results showed that the HBsAg positive rates in age groups of 20-<40 years and 40-<60 years were 9.48% and 9.57%, respectively, which were higher than those in age groups of <20 years (1.43%) and ≥60 years (2.75%) (all P<0.05). A total of 17 HBV serological marker patterns were observed, among which the proportion of all markers negative was the highest, at 39.65%. The proportions of "small three positive" (HBsAg+, HBeAb+, HBcAb+) and "large three positive" (HBsAg+, HBeAg+, HBcAb+) patterns were 4.77% and 1.50%, respectively. Among HBsAg-positive individuals, the proportions of the "small three positive" pattern across age groups were 0, 45.45%, 90.00%, and 81.82%, while those of the "large three positive" were 0, 36.36%, 5.00%, and 0, with statistically significant differences across age groups (both P<0.05).
Conclusions
The positive rate of HBsAg among outpatients in medical institutions in Jiaxing City is relatively high, with a notable proportion of individuals showing either no immunity or non-response to vaccination. It is recommended to strengthen hepatitis B immunization efforts among the population aged 20-<60 years, and to enhance monitoring and interventional treatment for "small three positive" and "large three positive" patterns.
4.Dose analysis of eye lens and fingers of interventional radiology workers in Baoji City, China
Xinmei HU ; Zhongli WANG ; Zhigang JI ; Hui CHAO ; Guangping KOU
Chinese Journal of Radiological Health 2025;34(3):336-342
Objective To investigate the eye lens and hand dose levels of interventional radiology workers in Baoji City, China, and to provide data reference for radiation protection. Methods In two general hospitals, the eye lens and finger doses of 121 interventional radiology workers were monitored between 2021 and 2023. The average annual dose levels and dose distribution were analyzed based on years, job positions, surgical sites, and duties during surgery. Results The average annual dose to the eye lens was 3.36 mSv, with the highest dose of 16.36 mSv. The average annual dose to the fingers was 3.38 mSv, with the highest dose of 17.72 mSv. The average annual dose to the eye lens and fingers decreased from 2021 to 2023. The average annual dose to the eye lens of the interventional surgeons was higher than those of the technicians and nurses, while the average annual dose to the fingers of the interventional surgeons was higher than that of the technicians. The average annual doses to the eye lens and fingers of the first operator were similar to those of the second operator, but both were higher than other personnel involved in the interventional surgery, and the differences were statistically significant (all P < 0.05). There were linear regression relationships between the annual doses to the eye lens and fingers and the effective whole-body dose of the interventional radiology workers. A paired test was conducted on the annual dose to the eye lens and fingers of the interventional workers for different surgical sites. The cardiovascular and peripheral vascular interventional workers had higher average annual doses to the eye lens than to the fingers, the cerebrovascular interventional workers had a higher average annual dose to the fingers than to the eye lens, and the differences were statistically significant. Conclusion The annual doses to the eye lens and fingers of the interventional radiology workers in Baoji City were lower than the national limits. However, some workers showed eye lens annual doses close to the new international standard limit (20 mSv). Special attention should be given to interventional physicians, especially the first and second surgeons.
5.Exploration on the Effects of Tuina on Glutamate Content and Synaptic Ultrastructure in Spinal Dorsal Horn of Rats with Chronic Sciatic Nerve Compression Injury Based on the SNAP25/VGLUT2 Pathway
Jingjing JIANG ; Limei HUANG ; Hongye HUANG ; Hengchang CAI ; Huanzhen ZHANG ; Lechun CHEN ; Shuijin CHEN ; Shiye WU ; Hui LIN ; Zhigang LIN
Chinese Journal of Information on Traditional Chinese Medicine 2025;32(4):113-119
Objective To observe the effect of tuina on glutamate content and synaptic ultrastructure in spinal dorsal horn of rats with chronic sciatic nerve compression injury;To explore the potential mechanism of tuina regulation of the SNAP25/VGLUT2 pathway in alleviating lumbar disc herniation.Methods A chronic sciatic nerve compression injury model was used to simulate neuropathic pain in lumbar disc herniation.24 SD rats were randomly divided into blank group,model group and tuina group,with 8 rats in each group.From the 4th day after modeling,the tuina group was intervened with the tuina method for 10 minutes once a day for 14 consecutive days.The paw withdrawal threshold(PWT)and paw withdrawal latency(PWL)of rats in each group on the day before modeling,and the 4th,10th,14th and 17th days after modeling were detected.The spinal cord tissue of the modeling side was taken,synaptic ultrastructure of spinal dorsal horn neurons was observed using transmission electron microscopy,immunofluorescence staining was used to detect the expression of NR2A in the spinal dorsal horn,Western blot was used to detect the expression of SNAP25 protein in the spinal dorsal horn,immunohistochemistry was used to detect the expression of VGLUT2 in the spinal dorsal horn,ELISA was used to detect the content of glutamate in the spinal dorsal horn.Results Compared with the blank group,PWT and PWL of the model group were significantly reduced on the 4th,10th,14th and 17th days after modeling(P<0.001),with accumulation of vesicles in the presynaptic membrane of the dorsal horn of the spinal cord,increase in the area of the postsynaptic dense zone,and enlargement of the synaptic cleft,while the protein expressions of NR2A,SNAP25 and VGLUT2 in the spinal dorsal horn increased(P<0.05,P<0.001),and the content of glutamate increased(P<0.001).Compared with the model group,PWT and PWL of the tuina group rats significantly increased on the 10th,14th and 17th days after modeling(P<0.001),synaptic vesicles were evenly distributed,the area of the postsynaptic dense zone decreased,and the synaptic cleft decreased,while the protein expressions of NR2A,SNAP25 and VGLUT2 in the spinal dorsal horn decreased(P<0.05,P<0.001),and the content of glutamate decreased(P<0.01).Conclusion Tuina may regulate the content of glutamate through the SNAP25/VGLUT2 pathway in the spinal dorsal horn,improve the synaptic ultrastructure of neurons,and have an analgesic effect on lumbar disc herniation.
6.Analysis of influencing factors of severe influenza B virus pneumonia complicated with invasive pulmonary aspergillosis
Zhigang ZHAO ; Hui LIU ; Hongmei LIU
Tianjin Medical Journal 2025;53(7):736-740
Objective To investigate the clinical characteristics and risk factors of severe influenza B viral pneumonia complicated with invasive pulmonary aspergillosis.Methods Forty-six patients with severe influenza B virus pneumonia were collected and divided into the invasive pulmonary aspergillosis(IPA)group(17 cases)and the control group(29 cases)based on whether they were complicated with IPA.The clinical manifestations,laboratory indicators,chest CT imaging findings,bronchoscopic manifestations,broncho alveolar lavage fluid(BALF)culture and metagenomic next-generation sequencing results were compared between the two group.Treatment conditions and final treatment outcomes were also compared between the two groups.Univariate and multivariate Logistic regression analyses were conducted to explore risk factors of severe influenza B virus pneumonia complicated with IPA.Results After treatment,a total of 6 patients died(35.30%),all of whom were in the invasive pulmonary aspergillosis group.In both groups,the symptoms of dyspnea,cough,expectoration and chest pain were more severe,and systemic symptoms such as fatigue,fever and muscle pain were also quite obvious.There were no significant differences in clinical symptoms,combined bacterial infection and hormone use between the two groups.Compared with the control group,white blood cell count,neutrophil count,blood GM test and BALF GM test were higher in the combined group.The proportion of patients with nodules and patchy shadows on imaging and the proportion of patients showing pseudomembrane manifestations under bronchoscopy were higher(P<0.05).Univariate Logistic regression analysis showed that white blood cell count,GM in BALF,nodules and patchy shadows in lung imaging and pseudomembrane manifestations under bronchoscopy were influencing factors for severe influenza B virus pneumonia combined with invasive pulmonary aspergillosis(P<0.05).Multivariate Logistic regression analysis showed that GM≥1 in BALF and pseudomembrane manifestations under bronchoscopy were risk factors for severe influenza B virus pneumonia combined with invasive pulmonary aspergillosis(P<0.05).Conclusion When GM test level of BALF in patients with severe influenza B virus pneumonia is≥1 and pseudomembrane manifestations are seen under bronchoscopy,the possibility of combined invasive pulmonary aspergillus infection should be highly vigilant.
7.Comparative efficacy of navigation system and orthopedic robot-assisted nail placement in the treatment of lower cervical fracture and dislocation
Xinnan CHENG ; Shuai LI ; Jiaojiao BAI ; Qingda LI ; Yukuan LEI ; Lei ZHU ; Zhen CHANG ; Zhigang ZHAO ; Yunfei HUANG ; Mingzhe FENG ; Liang YAN ; Hua HUI ; Lingbo KONG ; Baorong HE
Chinese Journal of Trauma 2025;41(2):148-156
Objective:To compare the clinical efficacy of navigation system and orthopedic robot-assisted nail placement in the treatment of lower cervical fracture and dislocation.Methods:A retrospective cohort study was conducted to analyze the clinical data of 49 patients with fracture and dislocation of the lower cervical spine who were admitted to Honghui Hospital, Xi′an Jiaotong University School of Medicine from May 2021 to October 2022, including 38 males and 11 females, aged 29-61 years [(39.3±7.3)years]. Injury segments involved C 3 in 12 patients, C 4 in 11, C 5 in 8, C 6 in 9 and C 7 in 9. Twenty-one patients were treated with S8 navigation system (navigation group, 84 screws), and 28 with TINAVI orthopedic robot (robot group, 112 screws). The two groups were compared in terms of the total surgical duration, single screw placement time, total screw placement time, distance between the screw and the anterior cortex, incision length, intraoperative radiation dose, intraoperative blood loss and length of hospital stay. The height of intervertebral space, Cobb angle, sliding distance between vertebral bodies and American Spinal Injury Association (ASIA) grade were assessed before surgery and at 3 days after surgery. Visual analogue scale (VAS), Japanese Orthopedic Association (JOA) score and neck dysfunction index (NDI) before surgery, at 3 days, 3 months after surgery and at the last follow-up were compared. The accuracy of screw placement, intraoperative invasion rate of adjacent facet joints and rate of postoperative complications (infection, screw loosening, etc.) were evaluated. Results:All the patients were followed up for 12-16 months [(13.6±1.9)months]. In the navigation group, the total surgical duration, distance from the screw to the anterior cortex and the intraoperative radiation dose were (236.2±30.6)minutes, (2.0±0.2)mm and (374.3±90.3)mGy respectively, which were significantly shorter or less than those in the robot group [(278.4±20.7)minutes, (10.6±2.9)mm and (448.4±77.9)mGy] ( P<0.01). The single screw placement time, total screw placement time, incision length and intraoperative blood loss were (3.5±0.4)minutes, (23.9±0.5)minutes, (9.1±2.4)cm and (422.2±30.4)ml respectively, which were significantly longer or more than those in the robot group [(2.6±0.2)minutes, (17.9±0.7)minutes, (6.6±2.6)cm and (360.3±56.3)ml] ( P<0.01). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). No significant differences were observed in the height of the intervertebral space, Cobb angle, sliding distance between the vertebral bodies and ASIA grade between the two groups ( P>0.05). At 3 days after surgery, the height of intervertebral space, Cobb angle, sliding distance between vertebral bodies and ASIA grade in both groups were significantly improved when compared with those before surgery ( P<0.05 or 0.01). There were no significant differences in VAS, JOA scores or NDI between the two groups before surgery, at 3 days, 3 months after surgery and at the last follow-up ( P>0.05). The VAS, JOA scores and NDI in both groups were gradually improved at 3 days, 3 months and at the last follow-up after surgery when compared with those before surgery ( P<0.05). There was no significant difference in the accuracy of screw placement of levels 0 and 0+1 between the two groups ( P>0.05). No significant difference in the intraoperative invasion rate of adjacent facet joints between the two groups was found ( P>0.05). There were no serious complications such as infection or screw loosening after surgery in both groups. Conclusions:For lower cervical fracture and dislocation, although there are more advantages in total surgical duration, screw holding force and radiation control regarding the navigation system, and more outstanding performance in screw placement efficiency, incision length and intraoperative blood loss regarding the orthopedic robot, both of them can effectively rebuild the cervical structure, improve neurological function, relieve postoperative pain, improve screw placement accuracy and reduce facet joint injury and serious complications. Selection of the best auxiliary screw placement system should comprehensively consider patients′ conditions and the experience of the surgical team.
8.Effect of CHRNA5 in occurrence and development of pancreas cancer and its mechanism
Dayou DAI ; Zhigang ZHANG ; Hui LI
Journal of Jilin University(Medicine Edition) 2025;51(6):1518-1531
Objective:To investigate the effects of cholinergic receptor nicotinic alpha 5 subunit(CHRNA5)on the invasion and proliferation of pancreatic ductal adenocarcinoma(PDAC)using bioinformatics approaches and cellular experiments,and to analyze its regulatory pathways and provide foundation for the identification of novel therapeutic targets for pancreatic cancer.Methods:Transcriptome,gene variation,and clinical data of pan-tumor and normal tissues were downloaded from public databases including The Cancer Genome Atlas(TCGA)and Genotype-Tissue Expression(GTEx).The expression levels of CHRNA5 mRNA between pan-tumor patients and healthy individuals were compared using Wilcoxon test.The expression levels of CHRNA5 mRNA between PDAC and para-cancer tissues were further compared using datasets from the Gene Expression Omnibus(GEO)database.The data were divided into three groups according to the different expression levels of CHRNA5 mRNA using tertile method:CHRNA5 high expression group,CHRNA5 medium expression group,and CHRNA5 low expression group.Survival analysis was performed in CHRNA5 high expression and low expression groups to assess the impact of CHRNA5 in prognosis of pancreas cancer.Real-time fluorescence quantitative PCR(RT-qPCR)and immunohistochemistry methods were used to detect the expressions of CHRNA5 mRNA and protein in tumor tissue,paracancer tissue,tumor cells and normal cells.Differential analysis of the transcriptome data and enrichment analysis of Hallmark genes and Reactome pathways were then conducted.Immune cell infiltration analysis was performed on PDAC based on transcriptome data.Tumor mutation burden(TMB)analysis,single nucleotide variation(SNV),and copy number variation(CNV)analysis were also conducted.The small interfering RNA(si)-NC and si-CHRNA5 were transfected into the MIA PaCa-2 and Capan-2 cells,and the samples were divided into NC,siRNA-1 and siRNA-2 groups according to the transfected siRNA.The proliferation activities of the cells in various groups under acetylcholine(Ach)and non-ACh conditions were detected using cell counting kit-8(CCK-8)method,and the expression of c-Myc protein in the cells in various groups were detected using Western blotting method.Results:Compared with normal tissue,the expression levels of CHRNA5 mRNA were elevated in 28 types of tumor tissues,including pancreatic cancer(adjusted P<0.05).The results of RT-qPCR and immunohistochemistry revealed that CHRNA5 was highly expressed in tumor tissue and pancreatic ductal adenocarcinoma(PDAC)cells compared with paracancer tissue and normal pancreatic ductal cells.The survival analysis showed that the PDAC patients with high expression of CHRNA5 had worse prognosis compared with those with low expression of CHRNA5.A total of 994 differentially expressed genes(DEGs)were identified between PDAC and control samples,with 381 up-regulated genes and 613 down-regulated genes.The gene Set Enrichment Analysis(GSEA)results indicated that CHRNA5 was highly associated with oxidative phosphorylation,cell proliferation,immune infiltration,and cell cycle.The immune analysis results showed that the samples with high expression of CHRNA5 had poorer immune infiltration compared with those with low expression of CHRNA5.Compared with CHRNA5 low expression group,the mutation rates of pancreatic cancer progression-related genes KRAS,TP53,and SMAD4 in CHRNA5 high expression group were increased.In cell experiments,compared with NC+Ach group,the proliferation activities of the cells in siRNA-1+Ach group and siRNA-2+Ach group were significantly decreased(P<0.05).The results of Western blotting revealed that the expression amounts of c-Myc protein in siRNA-1 and siRNA-2 groups were significantly lower than those in NC group.Conclusion:CHRNA5 modulates the cell cycle via myelocytomatosis viral oncogene(MYC)family,thereby influencing the proliferation of pancreas cancer cells and promoting the progression of PDAC,suggesting that CHRNA5 is a potential therapeutic target for pancreas cancer.
9.Comparative efficacy of navigation system and orthopedic robot-assisted nail placement in the treatment of lower cervical fracture and dislocation
Xinnan CHENG ; Shuai LI ; Jiaojiao BAI ; Qingda LI ; Yukuan LEI ; Lei ZHU ; Zhen CHANG ; Zhigang ZHAO ; Yunfei HUANG ; Mingzhe FENG ; Liang YAN ; Hua HUI ; Lingbo KONG ; Baorong HE
Chinese Journal of Trauma 2025;41(2):148-156
Objective:To compare the clinical efficacy of navigation system and orthopedic robot-assisted nail placement in the treatment of lower cervical fracture and dislocation.Methods:A retrospective cohort study was conducted to analyze the clinical data of 49 patients with fracture and dislocation of the lower cervical spine who were admitted to Honghui Hospital, Xi′an Jiaotong University School of Medicine from May 2021 to October 2022, including 38 males and 11 females, aged 29-61 years [(39.3±7.3)years]. Injury segments involved C 3 in 12 patients, C 4 in 11, C 5 in 8, C 6 in 9 and C 7 in 9. Twenty-one patients were treated with S8 navigation system (navigation group, 84 screws), and 28 with TINAVI orthopedic robot (robot group, 112 screws). The two groups were compared in terms of the total surgical duration, single screw placement time, total screw placement time, distance between the screw and the anterior cortex, incision length, intraoperative radiation dose, intraoperative blood loss and length of hospital stay. The height of intervertebral space, Cobb angle, sliding distance between vertebral bodies and American Spinal Injury Association (ASIA) grade were assessed before surgery and at 3 days after surgery. Visual analogue scale (VAS), Japanese Orthopedic Association (JOA) score and neck dysfunction index (NDI) before surgery, at 3 days, 3 months after surgery and at the last follow-up were compared. The accuracy of screw placement, intraoperative invasion rate of adjacent facet joints and rate of postoperative complications (infection, screw loosening, etc.) were evaluated. Results:All the patients were followed up for 12-16 months [(13.6±1.9)months]. In the navigation group, the total surgical duration, distance from the screw to the anterior cortex and the intraoperative radiation dose were (236.2±30.6)minutes, (2.0±0.2)mm and (374.3±90.3)mGy respectively, which were significantly shorter or less than those in the robot group [(278.4±20.7)minutes, (10.6±2.9)mm and (448.4±77.9)mGy] ( P<0.01). The single screw placement time, total screw placement time, incision length and intraoperative blood loss were (3.5±0.4)minutes, (23.9±0.5)minutes, (9.1±2.4)cm and (422.2±30.4)ml respectively, which were significantly longer or more than those in the robot group [(2.6±0.2)minutes, (17.9±0.7)minutes, (6.6±2.6)cm and (360.3±56.3)ml] ( P<0.01). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). No significant differences were observed in the height of the intervertebral space, Cobb angle, sliding distance between the vertebral bodies and ASIA grade between the two groups ( P>0.05). At 3 days after surgery, the height of intervertebral space, Cobb angle, sliding distance between vertebral bodies and ASIA grade in both groups were significantly improved when compared with those before surgery ( P<0.05 or 0.01). There were no significant differences in VAS, JOA scores or NDI between the two groups before surgery, at 3 days, 3 months after surgery and at the last follow-up ( P>0.05). The VAS, JOA scores and NDI in both groups were gradually improved at 3 days, 3 months and at the last follow-up after surgery when compared with those before surgery ( P<0.05). There was no significant difference in the accuracy of screw placement of levels 0 and 0+1 between the two groups ( P>0.05). No significant difference in the intraoperative invasion rate of adjacent facet joints between the two groups was found ( P>0.05). There were no serious complications such as infection or screw loosening after surgery in both groups. Conclusions:For lower cervical fracture and dislocation, although there are more advantages in total surgical duration, screw holding force and radiation control regarding the navigation system, and more outstanding performance in screw placement efficiency, incision length and intraoperative blood loss regarding the orthopedic robot, both of them can effectively rebuild the cervical structure, improve neurological function, relieve postoperative pain, improve screw placement accuracy and reduce facet joint injury and serious complications. Selection of the best auxiliary screw placement system should comprehensively consider patients′ conditions and the experience of the surgical team.
10.Exploring the hemodynamic changes of the ascending aorta before and after interventricular septal myocardial resection in obstructive hypertrophic cardiomyopathy by CMR 4D Flow technology
Xinyi LUO ; Guanyu LU ; Jiehao OU ; Yuelong YANG ; Liqi CAO ; Zhigang WU ; Jinglei LI ; Hui LIU
Journal of Chinese Physician 2024;26(1):25-30
Objective:To investigate the hemodynamic changes in the ascending aorta (AAo) before and after interventricular septal myocardial resection in obstructive hypertrophic cardiomyopathy (HOCM) using cardiac magnetic resonance four-dimensional blood flow (CMR 4D Flow) technology.Methods:HOCM patients who underwent interventricular septal myocardial resection at Guangdong Provincial People′s Hospital from May 2021 to September 2022 were prospectively included. Age and gender matched healthy volunteers (control group) were included during the same period. Both the control group and HOCM patients underwent CMR examination (including cine sequence and 4D Flow sequence) before and 6 months after surgery. CMR 4D flow technology was used to evaluate changes in AAo preoperative and postoperative blood flow patterns (eddy currents, spiral flow), maximum energy loss (EL max), and average energy loss (EL avg). HOCM patients underwent laboratory tests, including N-terminal pro-brain natriuretic peptide (N-pro BNP) and high-sensitivity troponin T (hsTnT). At the same time, the correlation between postoperative energy loss in HOCM patients and the degree of improvement in laboratory biomarkers was explored. Results:A total of 15 HOCM patients and 15 healthy volunteers were included. (1) In terms of blood flow patterns, the preoperative spiral flow degree of HOCM patients was significantly higher than that of the control group ( P=0.001), but the postoperative difference was not statistically significant ( P=0.059). The degree of eddy currents in HOCM patients before and after surgery was higher than that in the control group (all P<0.05). (2) In terms of energy loss, the preoperative EL max [21.17(14.30-28.10)mW vs 10.17(7.66-13.07)mW, P<0.001] and EL avg [4.87(3.46-5.77)mW vs 2.27(2.19-2.27)mW, P=0.023] of HOCM patients were higher than those of the control group, but there was no statistically significant difference between the postoperative and control groups (all P>0.05). Compared with preoperative, the postoperative EL max [12.33(8.70-17.41)mW] and EL avg [3.10(2.25-4.40)mW] of AAo in HOCM patients were significantly reduced (mean P=0.001). (3) Correlation analysis showed that there was a positive correlation ( r=0.587, P=0.021) between the EL max of AAo and the degree of improvement in hsTNT after interventricular septum myocardial resection, but no significant correlation ( r=0.229, P=0.413) with the degree of improvement in NT-pro BNP. Conclusions:The degree of postoperative AAo blood flow disorder in HOCM patients is reduced, and EL max and EL avg are significantly reduced. The EL max of postoperative AAo is positively correlated with the degree of improvement in hsTNT, suggesting that EL max may be applicable for prognostic evaluation of patients.


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