Analysis of time-space variations during dynamic cervical spine motion in cervical spondylosis myelopathy patients

BACKGROUND CONTEXTDecreased cervical range of motion (ROM) is a common symptom of myelopathy patients. Many previous studies have relied on a variety of experimental approaches for quantifying static cervical range of motion. However, the change rules of time-space variation during dynamic cervical spine motion remains unknown.PURPOSETo develop and validate the effectiveness of a novel wearable robot-based sensor system, Analysis of Dynamic Cervical spine Motion (ADCM), in evaluating the dynamic cervical spine motion dysfunction of patients with cervical spondylotic myelopathy (CSM).STUDY DESIGN/SETTINGA cross-sectional study.PATIENT SAMPLEOne hundred forty consecutive healthy individuals (70 men and 70 women) and 120 CSM patients (60 men and 60 women) were enrolled in the present study.OUTCOME MEASURESThe cervical motion process parameters, including the flexion and extension ROM, the flexion and extension time, and the Japanese Orthopedic Association scores (JOA) for cervical spine were measured.METHODSTwo hundred and sixty consecutive participants were asked to wear ADCM system and then fully flex and extend their neck rapidly and evenly at tolerable maximum speed. The cervical motion process was recorded and converted into waveforms. Relevant waveform parameters were measured and analyzed. The number of complete flexion-extension motions in 10 seconds has been defined as 10s F–E cycles. The Japanese Orthopedics Association (JOA) scores of CSM patients were marked.RESULTSCSM patients had a lower number of 10s F–E cycles than healthy subjects. There were significant differences in flexion and extension time and ROM between two groups. The waveforms of myelopathy patients were wider and lower than those in healthy individuals. The average ratio value (defined as F) of wave height to wave width (a+b/c+d) could quantitatively reflect such differences of waveforms. The average F value was correlated with the JOA scores of the cervical motion function (r=0.7538), and F value declined as JOA scores decreased. According to receiver operating characteristic curve analysis, the optimal threshold value of the normal average ratio was more than 34.7.CONCLUSIONSADCM appears to be an objective and quantitative severity assessment tool for confirmed CSM patients by evaluating dynamic cervical spine motion dysfunction.     

骨桥蛋白与钙离子的相互作用及其在不同胆汁体系中对胆固醇成核效应的影响

目的:探究骨桥蛋白与钙离子的相互作用及其在不同胆汁体系中对胆固醇成核效应的影响。方法:选择2016年7月—2018年9月在我院治疗的100例胆固醇结石患者,将其分为单纯胆囊结石组和原发性胆管结石组各50例,再选取50例正常人作为对照组。采用酶联免疫法检测胆固醇结石患者和正常人胆汁中骨桥蛋白与钙离子的浓度,并采用Holan法测定3组研究对象在不同浓度骨桥蛋白与钙离子中的胆固醇成核时间。结果:单纯胆囊结石组和原发性胆管结石组患者的骨桥蛋白浓度均低于对照组,而钙离子浓度高于对照组,差异有统计学意义(P<0.05)。单纯胆囊结石组和原发性胆管结石组不同浓度的骨桥蛋白及钙离子的胆固醇成核时间均少于对照组,差异有统计学意义(P<0.05)。与同组50μg/mL浓度的骨桥蛋白相比,骨桥蛋白100μg/mL浓度的胆固醇成核时间更长,而骨桥蛋白50μg/mL+钙离子10 mmol/L浓度的胆固醇成核时间更短,差异有统计学意义(P<0.05)。与同组100μg/mL浓度的骨桥蛋白相比,骨桥蛋白100μg/mL+钙离子10 mmol/L浓度的胆固醇成核时间更短,差异有统计学意义(P<0.05)。结论:骨桥蛋白在不同胆汁体系中对胆固醇成核效应发挥抑制作用,而钙离子发挥促进作用。骨桥蛋白延长钙离子的促成核时间,钙离子缩短骨桥蛋白的抑成核时间,二者互相影响。     

Screw-only fibular construct for Weber B ankle fractures: A retrospective clinical and cost comparison to assess feasibility for resource-limited settings

IntroductionAnkle fractures are one of the most common injuries sustained worldwide, with the majority being isolated lateral malleolus fractures. The majority of the world's population live in Low and Middle Income Countries (LMIC), where implant cost may limit surgical treatment of ankle fractures. We investigate if Weber B ankle fractures could be effectively treated with a lower-cost technique using two screws between the fibula and the tibia to neutralize an interfragmentary lag screw.MethodsAfter IRB approval, consecutive patients from January 1, 2020 to December 31, 2020 with Weber-B ankle fractures were treated using AO technique (AOT) with plate osteosynthesis neutralizing an interfragmentary screw. Syndesmotic injuries, as well as injuries to the medial malleolus or foot were treated according to the surgeon's preferences. From January 1, 2021 to December 31, 2021 these injuries were treated with a screw-only technique (SOT) with two fibula pro tibia screws to neutralize an interfragmentary screw. Patient demographics including age, sex, BMI, smoking status, associated rheumatoid arthritis, and associated diabetes mellitus were recorded. The primary outcome variable was a stable radiographic mortise at six weeks post-surgery, secondary outcome variables included clinical union, infection, hardware removal, and implant cost for lateral malleolar fixation charged to the hospital.ResultsSeventeen AOT and 10 SOT constructs were included. Demographic characteristics were similar between groups. All fractures maintained a stable mortise with clinical union at 6 weeks without infection. There was a statistically significant difference in hardware removal (17.6% AOT, 50% SOT, p = 0.012). The average implant cost to the hospital of the lateral malleolar fixation was significantly less in the SOT group ($592 (SD $229)), compared to the AOT group ($1,949.97 (SD $562)), (p < 0.0001).ConclusionWe introduce proof of concept of a novel lower-cost fixation strategy for Weber B ankle fractures that maintained a stable mortise with clinical union at six weeks post-surgery. However, there was a significantly higher rate of hardware removal following fixation with a screw-only construct.     

抑制ERK1/2对大鼠脑缺血再灌注损伤的保护作用

目的 探讨抑制细胞外调节蛋白激酶（ERK）1/2对脑缺血再灌注（I/R）损伤大鼠的作用及对缝隙连接蛋白（Cx）40/Cx43异型缝隙连接表达以及核因子-κB（NF-κB）相关炎症因子p-IκBa、肿瘤坏死因子（TNF）-α及干扰素（IFN）表达的影响。方法 选取成年雄性100只大鼠随机分为5组,每组20只:假手术组（仅暴露双侧颈总动脉而不夹闭）;治疗组4 h组和治疗组8 h组（I/R后立即腹腔注射ERK1/2特异性抑制剂SCH772984,25 mg/kg）;④溶媒组（I/R后立即腹腔注射溶媒二甲基亚枫）;⑤模型组（阻断双侧颈总动脉血流30 min后,恢复血流,产生I/R损伤）。采用神经功能损伤程度量表（NSS）评分评估大鼠神经功能。采用干湿重法测定脑组织含水率。采用免疫印迹法测定损伤侧海马区皮质p-IκBa、TNF-α及IFN的表达,采用免疫共沉淀法检测Cx40/Cx43异型连接表达。结果 模型组NSS评分脑含水率、p-IκBa、TNF-α、IFN及Cx40/Cx43异型连接的表达水平较假手术组均明显增高（P<0.05）,SCH772984干预后,均明显下降（P<0.05）。结论 抑制ERK1/2途径,可明显抑制Cx40/Cx43异型连接和NF-κB,减少炎症因子,缓解脑水肿,从而改善大鼠神经功能。     

PC-QoL问卷评价中药联合耳穴治疗对1~6岁慢性咳嗽患儿生活质量的影响

目的应用父母代理咳嗽特异性生活质量问卷(PC-QoL)评价中药联合耳穴贴压对1~6岁慢性咳嗽患儿生活质量的影响。方法纳入2017年8月—2018年9月在上海中医药大学附属龙华医院、上海市奉贤区中医医院、上海市嘉定区中医医院、上海市第七人民医院、上海市浦东新区中医医院儿科门诊就诊的1~6岁慢性咳嗽患儿226例,随机分为单纯中药组和中药+耳穴组,每组113例。单纯中药组给予小儿久咳方加减治疗2周,痰湿恋肺证(湿咳)加半夏3 g、陈皮3 g、胆南星3 g;风邪伤肺证(干咳)加僵蚕5 g、射干3 g、木蝴蝶1.5 g。中药+耳穴组中药治疗同单纯中药组,同时给予耳穴贴压2周(选择肺、气管、神门穴,湿咳加脾穴,干咳加肝穴,单侧贴压,每周换药1次,贴压对侧耳穴)。制定PC-QoL问卷,并进行信度和效度检测;采用PC-QoL问卷评价治疗前后患儿生活质量。结果PC-QoL问卷的各项评分Cranbach’sα均>0.8,KMO均>0.8,有较好的信度和效度。不同病因患儿生理、心理、社会评分及总分比较差异均有统计学意义(P均<0.05),抽动症咳嗽、咳嗽变异性哮喘、上气道咳嗽综合征、过敏性咳嗽、感染后咳嗽患儿生活质量依次递增。湿咳和干咳患儿生理、心理、社会评分及总分比较差异均无统计学意义(P均>0.05)。2组患儿治疗后生理、心理、社会评分及总分均明显增高(P均<0.05),且中药+耳穴组生理、心理评分及总分均明显高于单纯中药组(P均<0.05)。结论中药联合耳穴贴压治疗可明显改善1~6岁慢性咳嗽患儿的生活质量,PC-QoL问卷可作为评价1~6岁慢性咳嗽患儿生活质量的有效工具。     

Predicting complications of spine surgery: external validation of three models

BACKGROUND CONTEXTNumerous prediction tools are available for estimating postoperative risk following spine surgery. External validation and comparison of these tools is critical prior to clinical use. No model for adverse events after spine surgery has undergone decision curve analysis.PURPOSEExternal validation, comparison, and decision curve analysis of 3 previously described models [SpineSage, Risk Assessment Tool (RAT), National Surgical Quality Improvement Program Risk Calculator (NSQIP)] for predicting 30-day postoperative complications after spine surgerySTUDY DESIGNRetrospective cohort study.PATIENT SAMPLEThree hundred fifteen patients who underwent spine surgery at a tertiary academic surgical center in New Zealand between January 2019 and April 2020.OUTCOME MEASURESAs defined by each risk prediction tool and objectively using the Comprehensive Complication Index.METHODSWe retrospectively reviewed risk of postoperative complication was calculated for each patient according to the 3 models. Overall model fit, calibration, discrimination, and decision curve analysis for each model were assessed in line with the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines.RESULTS100 (35%) patients experienced complications. SpineSage and RAT were well calibrated, NSQIP systematically underestimated risk. Area under the curve was greatest for SpineSage (0.75) compared with the NSQIP (0.72) and the RAT (0.69). Decision curve analysis showed SpineSage resulted in greatest net benefit across all risk thresholds.CONCLUSIONSOf the models studied, SpineSage most accurately predicted risk and can be expected to perform better than a strategy of treating all patients if patient or surgeon deem complication risk >10% significant. NSQIP may not be suitable for the clinical use in our local population.     

胃癌患者术前血小板／淋巴细胞比值的预后意义

目的 探讨术前外周血血小板／淋巴细胞比值（PLR）对胃癌患者预后的影响。方法选取2008年9月至2009年12月在本院收治的184例胃癌患者作为研究对象,根据PLR是否＜150,将患者分为低PLR组（＜150）125例和高PLR组（≥150）59例,比较两组的临床病理特征和术后1、2、5年生存率及无病生存率,采用Cox风险回归模型评估影响胃癌患者预后的因素。结果 与低PLR组相比,高PLR组的肿瘤浸润深度深、淋巴结转移数多、TNM分期晚、白蛋白低（P＜0.05）。高PLR组和低PLR组1、2、5年生存率分别为74.6％、54.2％、37.3％ 和89.6％、77.6％、57.6％,两组差异有统计学意义（P=0002）。高PLR组和低PLR组1、2、5年无病生存率分别为52.56％、42.4％、23.7％ 和84.8％、72.0％、49.5％,两组差异有统计学意义（P＜0.001）。单因素分析显示,PLR、肿瘤浸润深度、淋巴结转移、TNM分期、年龄及白蛋白与总生存期（OS）和无病生存期（DFS）有关（P＜0.05）。Cox多因素分析显示,TNM分期是影响OS的独立预后因素（HR=6.344,95％CI：4.125～9.757,P＜0001）;TNM分期、PLR和白蛋白是影响DFS的独立预后因素（HR=4.600,95％CI：3.272～6.468,P＜0.001;HR=1.630,95％CI：1.070～2.483,P=0.023;HR=0.470,95％CI：0.259～0.853,P=0.013）。结论 术前PLR是影响胃癌DFS的独立预后因素,OS的预后意义需进一步研究。     

HPVL1壳蛋白联合MCM2检测对HPV DNA阳性患者宫颈病变的诊断及预后意义

目的:探讨HPVL1壳蛋白联合MCM2检测对HPV DNA阳性患者宫颈病变的诊断及随访的临床意义。方法:选取2010年1月至2015年1月门诊及住院患者,共531例。先行HPV DNA分型检测及活检确定病理类型,检测HPVL1和MCM2 在宫颈组织中的表达情况。结果:≥45岁的HPV DNA阳性患者宫颈病变发病数量明显增加;HPVL1 壳蛋白表达阳性率随宫颈病变恶性程度的增加而降低;随着宫颈病变加重,MCM2阳性比率逐渐上升,联合HPVL1检测,当同时HPVL1阴性,LSIL和HSIL两组中MCM2的阳性率分别为66.92%和90.91%（P=0.000）。HPVL1壳蛋白阳性病例自然消退 22例（78.57%）,持续存在5例（17.86%）,进展1例（3.57%）;HPVL1壳蛋白阴性病例自然消退13例（14.94%）,持续存在 67例（77.01%）,进展 7例（8.05%）。LSIL患者中HPVL1壳蛋白阳性和HPVL1壳蛋白阴性者相比,2年自然消退率HPVL1壳蛋白阳性者高（P=0.000）。结论:HPV DNA持续性感染是宫颈病变的高危因素;HPVL1壳蛋白表达的阳性率与宫颈病变的恶性程度呈负相关;通过联合检测HPVL1和MCM2,对判断和预测宫颈病变,尤其是区分LSIL和HSIL,比单独进行两项检测的价值更高;HPVL1壳蛋白在预测LSIL转归中可能有重要意义。     

临证运用杨悦娅“涤痰通络法”体会

总结杨悦娅教授对痰湿致病的认识。以异病同治思想为指导,在内科、妇科不同疾病表现出痰湿瘀阻的共同病机时,运用涤痰通络法为主治疗可取良效。在临床实践引入该法治疗慢性肾功不全也取得较好的疗效。     

口腔种植修复术在牙列缺损患者中的应用效果及对龈沟液中TNF-α、IL-6水平的影响

目的 探讨口腔种植修复术对牙列缺损患者的治疗效果及对龈沟液中肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)水平的影响。方法 选择2017年5月—2019年8月上海市浦东新区人民医院口腔科收治的84例牙列缺损患者,随机分为对照组(n=42)和实验组(n=42)。对照组采用常规修复方法,实验组采用口腔种植修复术治疗。治疗后6个月对疗效进行评估,比较2组患者龈沟液中TNF-α、IL-6水平,种植牙功能及并发症发生率。采用SPSS 18.0软件包对数据进行统计学分析。结果 实验组与对照组治疗后6个月TNF-α、IL-6水平显著高于治疗前(P<0.05);实验组治疗后6个月TNF-α、IL-6水平显著低于对照组(P<0.05);实验组与对照组治疗后6个月种植牙功能各项评分均显著高于治疗前(P<0.05);实验组治疗后6个月固位功能、语言功能、咀嚼功能及美观功能评分均显著高于对照组(P<0.05);实验组治疗过程中感染、刺痛感、核桩脱落、牙缺失发生率显著低于对照组(P<0.05)。结论 口腔种植修复术对牙列缺损患者龈沟液中的TNF-α、IL-6水平影响较小,种植牙功能提高,术后并发症发生率降低,值得临床推广应用。