目的：替扎尼定是具有解痉作用的α２肾上腺能受体激动剂，并具有一定的胃肠道保护作用，适用于单一治疗或与非甾体消炎药（NSAIDs）联合治疗急性痉挛性疼痛。通过替扎尼定和非甾体类抗炎药物的联合应用，临床观察和评估联合用药能否增强疗效和增加安全性。方法：急性痉挛性疼痛70例，随机分为两组，一组服用替扎尼定2mg,bid+双氯芬酸50 mg,bid，一组服用双氯芬酸50 mg,bid+安慰剂2mg,bid。观察药物疗效和不良反应。结果：联用组的总有效率为70％，胃肠道不良反应发生率为12%,中枢神经系统不良反应发生率为18％；单用组的总有效率为56％，胃肠道不良反应发生率为32％，中枢神经系统不良反应发生率为10％。结论：替扎尼定和非甾体类药物联用具有更好的疗效以及更高的药物耐受性。
Objective To evaluate the effectiveness of hormone replacement therapy (HRT) for osteoporosis in postmenopausal women. Method Systematic reviews and meta-analyses were searched in Cochrane Library (Issue 4, 2008), MEDLINE (1978-2008) and Clinical Evidence database. Search terms included Postmenopausal (post-menopausal) osteoporosis, therapy, vertebral fracture, hormone replacement therapy, randomized controlled trial, meta analysis, female,human. Result A total of 4 protocols were found in Cochrane Library and a meta-analyse was found in MEDLINE. The result demonstrated that both cancellous and cortical bone mineral density increased after HRT. Statistically significant reductions in the risk of vertebral and non-vertebral fracture were also found. Conclusion HRT can reduce the risk of osteoporotic fracture by increasing bone density. However, other disease and adverse event were also associated with the BMD increase. Therefore, both advantage and disadvantage should be considered before applying HRT therapy to postmenopausal osteoporosis patients.
In the surgical treatment of adolescent idiopathic scoliosis (AIS), the posterior pedicle screw system has a better orthopaedic effect than the traditional internal fixation orthopaedic system, and has been widely used in the orthopaedic surgery of AIS. Although the vast majority of patients respond well to surgical treatment, complications can still occur. Aortic injury is one of the rare complications, but it can lead to catastrophic consequences. Spinal surgeons must be fully familiar with the knowledge of aortic injury and the appropriate management and management methods. This article reviews the complication of aortic injury caused by surgical treatment of AIS.
Congenital scoliosis is the presence of a sideways curvature of the spine caused by the failure of normal vertebral development. Congenital scoliosis is usually progressive, and surgical treatment is crucial for the treatment of congenital scoliosis. Surgical treatments of congenital scoliosis mainly include simple fusion surgery, hemivertebrae excision, growing rods technique, and vertical expandable prosthetic titanium rib. However, there is no uniform standard for the selection of surgical techniques and surgical timing. This article reviews the progress of different surgical treatments for congenital scoliosis, introduces the classification of congenital scoliosis, and clarifies the timing, pros and cons of different surgical techniques, aiming to provide a reference for the development of individualized optimal surgical plans for patients with congenital scoliosis.
Polyetheretherketone is one of the most commonly used materials for the production of orthopaedic implants, but the osseointegration capacity of polyetheretherketone is poor because of its bioinert surface, which greatly limits its clinical application. In recent years, scholars have carried out a lot of research on the modification of polyetheretherketone materials in order to improve its osseointegration capacity. At present, the modification of polyetheretherketone is mainly divided into surface modification and blend modification. Therefore, this paper summarizes the research progress of polyetheretherketone material modification technology and its influence on osseointegration from two aspects of surface modification and blend modification for polyetheretherketone materials used in the field of bone repair, so as to provide a reference for the improvement and transformation of polyetheretherketone materials for bone repair in the future.
ObjectiveTo explore the effectiveness and safety of tranexamic acid (TXA) in anterior approach surgery for thoracolumbar fractures.MethodsFrom January 2017 to January 2020, a total of 68 thoracolumbar fracture patients undergoing anterior approach surgery were included and randomly divided into TXA group (n=33) and control group (n=35). Patients in the TXA group were given a dose of 15 mg/kg of TXA by intravenous infusion during 30 min before skin incision and an additional 15 mg/kg of TXA intravenously at 8 h after the first infusion, while the ones in the control group were given 15 mg/kg of normal saline at the same time. Basic data of the patients were collected. The hemoglobin concentration, hematocrit, coagulation and fibrinolysis indexes of the patients were monitored preoperatively, 24-hour postoperatively, and 72-hour postoperatively. The intraoperative blood loss and wound drainage of the patients were recorded. The incidence of blood transfusion and thrombotic events were collected. Statistical analysis was performed.ResultsThere was no significant difference in age, sex, body mass index, operation time, fracture location distribution, anesthesia classification of American Society of Anesthesiologists, neurologic grade of American Spinal Injury Association, injury time, or length of hospital stay between the two groups (P>0.05). Compared with those in the control group, the total blood loss [(1 398.49±312.24) vs. (1 642.30±357.78) mL, P=0.003], intraoperative blood loss [(432.83±74.76) vs. (486.31±86.51) mL, P=0.008], and wound drainage [(276.73±89.42) vs. (389.24±125.71) mL, P<0.001] in the TXA group reduced. No statistically significant difference was found between the two groups in the preoperative hemoglobin or hematocrit (P>0.05), but the 24-hour postoperative hemoglobin concentration [(112.67±20.59) vs. (102.64±19.41) g/L, P=0.042] and hematocrit [(32.25±4.12)% vs. (30.13±4.28)%, P=0.042] in the TXA group were higher than those in the control group. The incidence of allogeneic blood transfusion in the TXA group was lower than that in the control group (6.1% vs. 25.7%, P<0.05). There was no statistically significant difference in preoperative, 24-hour postoperative, or 72-hour postoperative prothrombin time, international standardized ratio, activated partial prothrombin time, platelet count, fibrinogen, d-dimer, or fibrinogen degradation products between the two groups (P>0.05), and no thrombotic complications were found.ConclusionTXA has good efficacy and safety in the anterior approach surgery for thoracolumbar fractures.
Objective To isolate and culture the chondroid cells and notochord cells from New Zealand rabbit immature nucleus pulposus (NP) in monolayer, and to valuate the responsiveness of rabbit disc-derived chondroid cells to notochord cells with respect to cell prol iferation and phenotype. Methods The NP cells were released from the minced immature NP of 6 New Zealand rabbits (4-week-old) by 0.2% collagenase II digestion. The chondroid cells and notochord cells were purified by discontinuous gradient density centrifugation. The chondroid cells were cultured alone (group A) andco-cultured with notochord cells (group B) (1 ∶ 1), and cell prol iferation and phenotype including proteoglycan and collagen II were evaluated. The cells in both groups were observed by the inverted microscope, and the survival rates of the primary and passage cells were detected by toluidine blue staining. The growth curves of the second passage cells in both groups were determined by MTT. Besides, the expressions of proteoglycan and collagen II of the primary and passage cells were examined by toluidine blue and immunocytochemistry staining. Results The notochord cells and chondroid cells were isolated and purified. With the diameter of 10-15 μm, the notochord cell had abundant intracytoplasmic vesicles, while the chondroid cell, with the diameter of 4-6 μm, had no intracytoplasmic vesicle. The cell survival rate was 89.0%-95.3% in group A and 91.3%-96.3% in group B. There was no significant difference between the same passages in both groups (P gt; 0.05). The co-cultured cells (group B) increased in cell prol iferation compared with the chondroid cells alone (group A) in repeated experiments. The cells in group A reached their logarithmic growth phase after 3-4 days of culture, while the cells in group B did after 2 days of culture. The cell prol iferation in group B was more than that in group A after 4-day culture (P lt; 0.05). The cocultured cells retained their phenotype for 5 passages, while parallel-cultured chondroid cells lost the expression of proteoglycan and collagen II after the third passage. Conclusion The notochord cells are conducive for the prol iferation and phenotypekeeping of the chondroid cells and may play a key role in preventing degeneration of the disc.
Objective To compare the molecular phenotype of human intervertebral disc cells and articular chondrocytes and to analyze whether hBMSCs can differentiate into both chondrocytes and nucleus pulposus cells after combined induction of TGF-β3 and BMP-7 in vitro. Methods The cells with the characteristics of hBMSCs were isolated from marrow aspirates of the volunteer donors’ il iac crest. Human bone marrow was removed and fractionated, and adherent cell cultures were establ ished. The 4th passage cells were then translated into an aggregate culture system in a serum-free medium. The pellet cultures of hBMSCs were divided into four groups: 10 ng/mL TGF-β3 group (group A), 200 ng/mL BMP-7 group (group B), combination group of TGF-β3 and BMP-7 (group C) and blank group as the control (group D). Histological observation, RT-PCR and RQ-PCR were appl ied to measure the expressions of collagen type I, II, X, aggrecan and SOX9 on the 4th and 21st day after cell induction, respectively. Results As was shown by histological observation, the induced cells expressed the feature of chondrocytes in morphology and ECM in groups A and C on the 21st day after the culture. And the collagen type II was positive after staining in groups A and C. The cell morphology of the induced cells in groups B and C had no obviouly changed. PCR detection showed that the expressions of SOX9, aggrecan, collagen type I, II in groups A and C at 21st day were more increased than those at 4th day (P lt; 0.05). The only expressions of collagen type I in groups B and D at 21st day were more increased than those at 4th day (P lt; 0.05). The expressions of collagen type X only was positive in group A. Conclusion Combination of TGF-β3 and BMP-7 can make the differentiated cells from hBMSCs much closer to intervertebral disc cells, so it perhaps could provide seed cells for intervertebral disc tissue engineering.
Objective To summarize the research progress of microRNA (miRNA) and its non-viral vector in intervertebral disc degeneration (IDD) and to investigate the potential of non-viral vector delivery of miRNA in clinical application. Methods The related literature about the role of miRNA in IDD and its non-viral delivery system was reviewed and analyzed. Results MiRNA can regulate the related gene expression level and further participate in the pathophysiologic process in degenerated intervertebral disc, miRNA delivered by various non-viral vectors has obtained an ideal effect in some diseases. Conclusion MiRNA plays a great role in the cellular and molecular mechanisms of IDD, as a safe and effective strategy for gene therapy, non-viral vector provides new possibilities for IDD treated with miRNA.
ObjectiveTo explore the feasibility of co-transduction and co-expression of Nogo extracellular peptide residues 1-40 (NEP1-40) gene and neurotrophin 3 (NT-3) gene into neural stem cells (NSCs).MethodsNSCs were derived from the cortex tissue of Sprague Dawley rat embryo. The experiment included 5 groups: no-load lentiviral vector transducted NSCs (group A), NEP1-40 transducted NSCs (group B), NT-3 transducted NSCs (group C), NEP1-40 and NT-3 corporately transducted NSCs (group D), and blank control (group E). Target genes were transducted into NSCs by lentiviral vectors of different multiplicity of infection (MOI; 5, 10, 15) for different time (24, 48, 72 hours). Fluorescent microscope was used to observe the expression of fluorescence protein and acquire the optimum MOI and optimum collection time. Real-time fluorescence quantitative PCR and Western blot tests were utilized to evaluate the gene expressions of NEP1-40 and NT-3 in NSCs and protein expressions of NEP1-40 and NT-3 in NSCs and in culture medium.ResultsThe optimum MOI for both target gene was 10 and the optimum collection time was 48 hours. The real-time fluorescence quantitative PCR and Western blot results showed that the mRNA and protein relative expressions of NEP1-40 in groups B and D were significantly higher than those in groups A and C (P<0.05), but no significant difference was found between groups B and D, and between groups A and C (P>0.05). The mRNA and protein relative expressions of NT-3 in groups C and D were significantly higher than those in groups A and B (P<0.05), but no significant difference was found between groups A and B, and between groups C and D (P>0.05).ConclusionNEP1-40 and NT-3 gene can be successfully co-transducted into NSCs by the mediation of lentiviral vector. The expressions of the two target genes are stable and have no auxo-action or antagonism between each other.