Relationships between anthropometric adiposity indexes and bone mineral density in a cross-sectional Chinese study

Background ContextPrevious studies have reported conflicting results for the relationships between anthropometric adiposity indexes and bone mineral density, based on dual-energy X-ray absorptiometry (DXA). However, few studies were published based on quantitative computed tomography (QCT), especially for Chinese population.PurposeTo evaluate the associations of spine bone mineral density (BMD) with body mass index (BMI), waist circumstance (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and a body shape index (ABSI) using QCT.Study Design/SettingA Cross-sectional study.Patient SampleAround 3,457 participants in multiple communities across 7 administrative regions of China.Outcome MeasuresSpine BMD was measured using QCT, and the classification of osteoporosis was defined as follows: 1) osteoporosis if BMD <80mg/cm³, 2) osteopenia if BMD 80–119 mg/cm³, and 3) normal bone mass if BMD≥120 mg/cm³.MethodsThis study was conducted using convenient sampling between 2013 and 2017. Multivariable linear regression model and logistic regression models were used for the associations of continuous and categorical BMD, respectively.ResultsAround 3,405 participants were included in the final analyses, including 1,272 males and 2,133 females, with spine BMD of 111.00±35.47 mg/cm³ and 99.38±40.60 mg/cm³, respectively. Spine BMD decreased significantly with the increase of ABSI in females (adjusted β, ?5.74; 95% confidence interval [CI], ?8.50 to ?2.98), and this trend also was kept in females aged at less than 60 years (adjusted β, ?14.54; 95% CI, ?20.40 to ?8.68), and females with age ≥60 years (adjusted β, ?7.59; 95% CI, ?10.91 to ?4.28). However, this inverse association was observed only in males with age ≥ 60 years (adjusted β, ?5.19; 95% CI, ?10.08 to ?0.29). Except ABSI, negative associations of Spine BMD with WC (adjusted β, ?0.46; 95% CI, ?0.77 to ?0.15), WHR (adjusted β, ?6.25; 95% CI, ?10.63 to ?1.86), WHtR (adjusted β, ?6.80; 95% CI, ?11.63 to ?1.97) were shown in females aged at <60 years, and positive association with BMI in males with age ≥60 years (adjusted β, 0.92; 95% CI, 0.29–1.55).ConclusionsABSI had more remarkable association with spine BMD, compared with the other four indexes.     

Usefulness of a Three‐Dimensional‐Printed Model in the Treatment of Irreducible Atlantoaxial Dislocation with Transoral Atlantoaxial Reduction Plate

ObjectiveTo evaluate the usefulness of a 3D‐printed model for transoral atlantoaxial reduction plate (TARP) surgery in the treatment of irreducible atlantoaxial dislocation (IAAD).MethodsA retrospective review was conducted of 23 patients (13 men, 10 women; mean age 58.17 ± 5.27 years) with IAAD who underwent TARP from January 2015 to July 2017. Patients were divided into a 3D group (12 patients) and a non‐3D group (11 patients). A preoperative simulation process was undertaken for the patients in the 3D group, with preselection of the TARP system using a 3D‐printed 1:1 scale model, while only imaging data was used for the non‐3D group. Complications, clinical outcomes (Japanese Orthopaedic Association [JOA] and visual analogue score [VAS]), and image measurements (atlas–dens interval [ADI], cervicomedullary angle [CMA], and clivus‐canal angle [CCA]) were noted preoperatively and at the last follow up.ResultsA total of 23 patients with a follow‐up time of 16.26 ± 4.27 months were included in the present study. The surgery duration, intraoperative blood loss, and fluoroscopy times in the 3D group were found to be shorter than those in non‐3D group, with statistical significance. The surgery duration was 3.29 ± 0.45 h in the 3D group and 4.68 ± 0.90 h in the non‐3D group, and the estimated intraoperative blood loss was 131.67 ± 43.03 mL in the 3D group and 185.45 ± 42.28 mL in the non‐3D group. No patients received blood transfusions. The intraoperative fluoroscopy times were 5.67 ± 0.89 in the 3D group and 7.91 ± 1.45 in the non‐3D group. Preoperatively and at last follow up, JOA and VAS scores and ADI, CCA, and CMA were improved significantly within the two groups. However, no statistical difference was observed between the two groups. However, surgical site infection occurred in 1 patient in the 3D group, who underwent an emergency revision operation of the removal of TARP device and posterior occipitocervical fixation; the patient recovered 2 weeks after the surgery. In 2 patients in the traditional group, a mistake occurred in the placement of screws, with no neurological symptoms related to the misplacement.ConclusionPreoperative surgical simulation using a 3D‐printed real‐size model is an intuitive and effective aid for TARP surgery for treating IAAD. The 3D‐printed biomodel precisely replicated patient‐specific anatomy for use in complicated craniovertebral junction surgery. The information was more useful than that available with 3D reconstructed images.     

The effect of synthetic oxygen carrier-enriched fibrin hydrogel on Schwann cells under hypoxia condition in vitro

Schwann cell (SC), which plays a key role in peripheral nerve regeneration, is one of the most classic supportive cells in neural tissue engineering. However, the biological activity of SCs seeded in nerve scaffolds decays subsequently due to local hypoxia induced by ischemia. Thus, we aimed to investigate whether a synthetic oxygen carrier-enriched fibrin gel would provide a sustained oxygen release to cultured SCs in vitro for overcoming a temporary (48 h) oxygen deprivation. In this study, perfluorotributylamine (PFTBA)-based oxygen carrying fibrin gel was prepared to provide oxygen for SCs under normoxic or hypoxic conditions. The dissolved oxygen within the culture media was measured by a blood-gas analyzer to quantify the time course of oxygen release from the PFTBA-enriched fibrin gel. SCs were cultured in the presence or absence of PFTBA-enriched fibrin gel under normoxic or hypoxic conditions. The tolerance of SCs to hypoxia was examined by a cell apoptosis assay. The growth of cells was characterized using S-100 staining and a CCK-8 assay. The migration of cells was examined using a Transwell chamber. The mRNA of brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), glial cell derived neurotrophic factor (GDNF), neural cell adhesion molecule (N-CAM) and vascular endothelial growth factor (VEGF) in SCs were assayed by RT-PCR. In addition, SCs cultured in 3D PFTBA-enriched hydrogel were characterized by Live/Dead staining and the mRNA levels of BDNF, NGF, GDNF, N-CAM and VEGF were assayed by RT-PCR. The results showed that the PFTBA-enriched fibrin hydrogel was able to promote cell adhesion, migration, and proliferation under hypoxic conditions. Interestingly, PFTBA applied through the fibrin hydrogel dramatically enhanced the mRNA of BDNF, NGF, GDNF, N-CAM and VEGF under hypoxic condition. These findings highlight the possibility of enhancing nerve regeneration in cellular nerve grafts through PFTBA increased neurotropic secretion in SCs.     

Open surgical embolectomy for cardiogenic cerebral embolism: Technical note and its advantages

Background and importanceIn cardiogenic cerebral embolism, early recanalization is the most important factor for good prognosis. However, endovascular thrombectomy often fails to achieve recanalization. We present an open surgical embolectomy technique and discuss its advantages.Clinical presentationA 79-year-old woman developed right hemiparesis and severe aphasia. Magnetic resonance imaging revealed an acute cerebral infarction caused by left middle cerebral artery (MCA) occlusion. We attempted endovascular thrombectomy but failed because it was impossible to guide the catheter to the occlusion site. Hence, we converted to open surgical embolectomy. Sylvian fissure was widely opened. After confirming the range of thrombosis using indocyanine green videoangiography (ICGVAG), the proximal and distal arteries were secured, and a temporary clip was placed on the distal M2 to prevent distal thrombosis migration. MCA was cut approximately 3 mm from the bifurcation, and thrombosis was removed using micro-forceps. The proximal clip was simultaneously inserted but was not clamped because the thrombus was extruded by proximal vascular flow. Immediately after removing the thrombus, intense bleeding occurred from the proximal flow. An assistant clamped the proximal artery using the prepared clip, and the incised area of MCA was sutured using 9-0 threads. We finally confirmed blood flow after recanalization using ICGVAG. The time from skin incision to recanalization was 27 min. After the procedure, the patient developed slight aphasia but had no hemiparesis and was later transferred to a rehabilitation hospital.ConclusionOpen surgical embolectomy may be a secondary rescue treatment option in the case of endovascular thrombectomy failure.     

The epigenetically active small chemical N-methyl pyrrolidone (NMP) prevents estrogen depletion induced osteoporosis

Currently, there are several treatments for osteoporosis however; they all display some sort of limitation and/or side effects making the need for new treatments imperative. We have previously demonstrated that NMP is a bioactive drug which enhances bone regeneration in vivo and acts as an enhancer of bone morphogenetic protein (BMP) in vitro. NMP also inhibits osteoclast differentiation and attenuates bone resorption.In the present study, we tested NMP as a bromodomain inhibitor and for osteoporosis prevention on ovariectomized (OVX) induced rats while treated systemically with NMP. Female Sprague–Dawley rats were ovariectomized and weekly NMP treatment was administrated 1 week after surgery for 15 weeks. Bone parameters and related serum biomarkers were analyzed. 15 weeks of NMP treatment decreased ovariectomy-induced gained weight in average by 43% and improved bone mineral density (BMD) and bone volume over total volume (BV/TV) in rat femur on average by 25% and 41% respectively. Moreover, mineral apposition rate and bone biomarkers of bone turnover in the treatment group were at similar levels with those of the Sham group.Due to the function of NMP as a low affinity bromodomain inhibitor and its mechanism of action involving osteoblasts/osteoclasts balance and inhibitory effect on inflammatory cytokines, NMP is a promising therapeutic compound for the prevention of osteoporosis.     

Gender analysis of the anterior femoral condyle geometry of the knee

BackgroundNo study has used 3-D anatomic knee models to investigate the gender differences in anterior femoral condyles. Therefore, this study aims to determine the morphologic differences between genders in anterior femoral condyles of the knees using 3-D anatomic knee models.MethodsNinety-six male and sixty-five female 3D anatomic knee models were used to measure lateral and medial anterior condyle heights, anterior trochlear groove heights, and anterior condyle width, which were normalized by the anterior–posterior and medial–lateral dimensions of the knee, respectively. The shape of anterior condyle groove was also analyzed.ResultsThe mean lateral anterior condyle height, medial anterior condyle height and anterior condyle width of females were 6.6 ± 1.8 mm, 2.0 ± 2.3 mm, and 44.7 ± 4.2 mm, respectively. These data were significantly smaller (p < 0.05) than those of males (7.7 ± 1.8 mm, 2.9 ± 2.0 mm and 50.0 ± 3.4 mm). However, after normalizing by the femur size, the aspect ratios had no gender differences. Both the ranges of lateral and medial condyle of females were significantly smaller than those of males, and the geometry curve of anterior condyle was different between genders.ConclusionAlthough the gender differences in anterior femoral condyle sizes no longer existed after normalization with the femur size, the shape and the peak position of anterior condyle groove still have gender differences. The data may have important implications on the current debate of gender-specific TKAs.Clinical relevanceThis study provides a better understanding of gender differences in anterior femoral condyle geometry.     

颅底凹陷症的分型及其意义

目的:探讨颅底凹陷症的分型方法,为其手术治疗方案的制定提供参考。方法:2007年3月～2010年3月我院收治颅底凹陷症患者70例,均行颅骨正侧位X线片及包含颅底部的颈椎CT和头颈部MRI检查,根据有无寰枢椎脱位或寰枕脱位将其分为稳定型和不稳定型,统计各型合并寰枕融合畸形、Chiari畸形、枢椎上关节面倾斜及脊髓空洞的例数,测量枕骨斜坡角、齿状突顶点到Chamberlain线的垂直距离和齿状突顶点到枕骨大孔连线的垂直距离,观察脊髓受压情况,记录手术方法。结果:20例为稳定型颅底凹陷症,其中合并Chiari畸形18例(90%),合并脊髓空洞15例(75%);50例为不稳定型,其中合并Chiari畸形2例(4%),寰枕融合46例(92%),枢椎上关节面倾斜37例(74%),脊髓空洞43例(86%)。稳定型枕骨斜坡角为168°±5°,不稳定型为133°±11°,无统计学差异(P<0.05);稳定型齿状突顶点与枕骨大孔线的垂直距离为0.5±0.3mm,不稳定型为-6.9±2.9mm,有统计学差异(P<0.05);稳定型齿状突顶点与Chamberlain线垂直距离为-4.8±4.2mm,不稳定型为-5.6±3.7mm,无统计学差异(P>0.05)。20例稳定型患者中,脊髓前方受压2例、后方受压11例、前后方均受压7例,均采用后颅窝减压手术治疗;50例不稳定型患者中,脊髓前方受压44例、前后方均受压6例,均采用经口咽前路复位钢板内固定手术治疗。结论:根据有无寰枢椎脱位或寰枕脱位可以将颅底凹陷症分为稳定型和不稳定型,这一分型方法对于正确认识两种不同类型颅底凹陷症的解剖学和临床特点,从而采取合理的手术方法进行治疗具有重要意义。     

内窥镜腰椎间盘切除术与开放式手术组织伤害的比较

目的　比较经皮内窥镜腰椎间盘切除术（PELD）和传统开放式手术(OD)对组织的伤害程度。 方法　前瞻性研究20例有症状腰椎间盘突出症患者,两组手术组随机收集10位患者,记录两组患者术中失血量、住院时间、切口大小。使用ELISA来测量IL-1β、IL-6、IL-8、IL-10、CRP、CPK在术前、术后1、6、12、24、48h的变化,术后使用VAS及改良MacNab 标准来评估术后临床疗效。 结果　内窥镜组患者相对于传统手术的血流量小(P＜0.01),更短的住院时间(P＜0.01),更小的手术切口(P＜0.01)。MacNab评估术后6个月两组均有90％满意度;术后3个月两组疼痛指数（P=0.661）无统计学意义;CRP、CPK、IL-6在术后24 h及48 h,开放手术组均高于内窥镜组(P＜0.01),有统计学意义。 结论　内窥镜椎间盘切除手术相对传统开放手术具有相似的短期临床效果,具有切口小、出血少、组织损伤轻和恢复快的特点。     

各型Hangman骨折稳定性的生物力学评价

目的 模拟建立各型Hangman骨折模型并测试其生物力学稳定性，为临床治疗提供生物力学依据。方法 6具新鲜C0-4尸体标本，依次按Levine—Edwards诊断标准依次制成Ⅰ型、ⅡA型和Ⅱ型Hang—man骨折模型，在脊柱三维运动试验机上依次按照①正常；②Ⅰ型骨折；③ⅡA型骨折；④Ⅱ型骨折顺序测试其三维运动范围(ROM)(因Ⅲ型骨折在生物力学实验模型上无法准确模拟，故未列入本次实验范围)。结果 自Ⅰ～Ⅱ型骨折，ROM值逐渐增大。Ⅰ型骨折组与对照组相比除旋转有显著性差异外，余均无显著性差异；ⅡA型骨折组及Ⅱ型骨折组与对照组相比均有显著性差异。ⅡA型骨折组与Ⅰ型骨折组相比除后伸无显著性差异外，余均有显著性差异，而Ⅱ型骨折组与Ⅰ型骨折组相比均有显著性差异。Ⅱ型骨折组与ⅡA型骨折组均有显著性差异。结论Hangman骨折稳定性自Ⅰ～Ⅱ型逐渐降低；Ⅰ型骨折为稳定性骨折，ⅡA型骨折稳定性强于Ⅱ型骨折，Ⅱ型为不稳定骨折。