Objective To observe the clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion. Methods A total of 41 patients with Hangman fracture were retrospectively analyzed, who underwent anterior cervical discectomy and fusion from May 2010 to May 2016. Intervertebral bone graft fusion was observed through postoperative radiographic images, and improvement of symptoms was evaluated by Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Modified Japanese Orthopaedic Association Scale (m-JOA). Surgical complications were evaluated as well. Results No severe complications occurred after surgery, but 5 patients had a transient dysphagia, which relieved spontaneously. Thirty-five patients had a fusion of intervertebral bone graft 3 months after surgery, and the remaining 6 patients did at the last follow-up. The VAS score was improved from 4.5±1.6 pre-operatively to 2.4±1.7 immediately post-operatively (P>0.05), and was further improved to 0.7±0.9 at the last follow-up (P<0.05). The NDI score was improved from 29.3±10.9 pre-operatively to 13.2±5.4 immediately post-operatively (P<0.05), and was further improved to 4.6±3.1 at the last follow-up (P<0.05). The m-JOA score was improved from 8.4±2.3 pre-operatively to 11.6±3.5 immediately post-operatively (P<0.05), and was further improved to 14.3±2.0 at the last follow-up (P<0.05). Conclusion Anterior cervical discectomy and fusion can be used in Hangman fracture, which is safe and reliable.
Objective To review the research advances in animal models of human disc degeneration. Methods The relative articles in recent years were extensively reviewed. Studies both at home and abroad were analyzed and classified. The advantages and disadvantages of each method were compared. Results Studies were classified as either experimentally induced models or spontaneous models. The induced models were subdivided as mechanical (alteration of forces on the normal disc), structural (injury or chemical alteration) and genetically induced models. Spontaneous models included those animals that naturally developed degenerative disc disease. Conclusion Animal model of intervertebral disc degeneration is an important path for revealing the pathogenesis of human disc degeneration, and play an important role in testing novel interventions. With recent advances in the relevance of animal models and humans, it has a great prospect in study of human disc degeneration.
Objective To investigate the effect and safety of the anterior uncovertebral joint resection in treatment of cervical spondylotic myelopathy accompanied by radiculopathy. Methods From March 2002 toJuly 2004, 9 patients (5 males, 4 females; aged 38-66) with cervical spondylotic myelopathy accompanied by radiculopathy underwent the anterior uncovertebral joint resection and discectomy using the titanium cage implantation. There were 6 unilateral and 3 bilateral compressed nerve roots. Results During the follow-up for 3-16 months, CT scanning or X-ray films revealed thatall the patients improved with an enlargement of the intervertebral foramen, and MRI demonstrated that compression of the spinal cord and nerve roots vanished.Seven patients had a relief in the radicular pain although the other 2 still had a residual pain. All the patients improved to some extent in symptoms of myelopathy. No patient suffered vertebral artery injury during the operation. Conclusion The uncovertebral joint resection can directly decompressthe nerve roots. The key to avoidance of an injury to the vertebral artery is agood understanding of the regional anatomy and a good performance of the operation.
In deep learning-based image registration, the deformable region with complex anatomical structures is an important factor affecting the accuracy of network registration. However, it is difficult for existing methods to pay attention to complex anatomical regions of images. At the same time, the receptive field of the convolutional neural network is limited by the size of its convolution kernel, and it is difficult to learn the relationship between the voxels with far spatial location, making it difficult to deal with the large region deformation problem. Aiming at the above two problems, this paper proposes a cascaded multi-level registration network model based on transformer, and equipped it with a difficult deformable region perceptron based on mean square error. The difficult deformation perceptron uses sliding window and floating window techniques to retrieve the registered images, obtain the difficult deformation coefficient of each voxel, and identify the regions with the worst registration effect. In this study, the cascaded multi-level registration network model adopts the difficult deformation perceptron for hierarchical connection, and the self-attention mechanism is used to extract global features in the basic registration network to optimize the registration results of different scales. The experimental results show that the method proposed in this paper can perform progressive registration of complex deformation regions, thereby optimizing the registration results of brain medical images, which has a good auxiliary effect on the clinical diagnosis of doctors.
Abstract： Objective To estimate the effectiveness and safety of intra-aortic balloon pump （IABP）in the patients with mild or mild to moderate aortic regurgitation. Methods A total of 15 patients with mild or mild to moderate aortic regurgitation and low left ventricular ejection fraction (LVEF＜ 40.00%) including 11 males and 4 females, who underwent IABP application after cardiac surgery between September 2006 and January 2011, were included in this study. Their age ranged from 50 to 74 years with an average age of 63.60 years. There were 9 patients with mild aortic regurgitation and 6 patients with mild to moderate aortic regurgitation, all with LVEF ＜ 40.00%. IABP catheters were inserted before operation and IABP worked after heart the recovery of heart beat. Mean aortic pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), LVEF , and aortic regurgitation volume before the use of IABP and after stopping use of it were compared. Results The total mortality was zero. The patients’ CI significantly improved from 1.99±0.23 L/(min.m2) to 3.30±0.29 L/(min.m2) after IABP （t =48.30，P=0.00）. Their LVEFs were significantly improved after use of IABP (37.20%±1.37% versus 42.60%±2.87%， t =11.34，P=0.00）. Their SVRI improved significantly (2 347.00±190.00 dyn·s/(cm5·m2) versus 2 128.00±204.00 dyn·s/(cm5 · m2)，t=20.60, P=0.00）after use of IABP. However, their aortic regurgitation volume were not significantly increased（χ2=0.60, P=0.44）. Conclusion Application of IABP in patients with mild or mild to moderate aortic regurgitation and low LVEF can obtain good circulation support after operation without increasing their aortic regurgitation.
Objective To summarize the research progress of stem cell transplantation in treating spinal cord injury (SCI) at different stages based on the pathophysiological mechanism of SCI. Methods The relevant research literature at home and abroad was extensively reviewed to explore the impact of transplantation timing on the effectiveness of stem cell transplantation in treating SCI. Results Researchers performed different types of stem cell transplantation for subjects at different stages of SCI through different transplantation approaches. Clinical trials have proved the safety and feasibility of stem cell transplantation at acute, subacute, and chronic stages, which can alleviate inflammation at the injured site and restore the function of the damaged nerve cells. But the reliable clinical trials comparing the effectiveness of stem cell transplantation at different stages of SCI are still lacking. Conclusion Stem cell transplantation has a good prospect in treating SCI. In the future, the multi-center, large sample randomized controlled clinical trials are needed, with a focus on the long-term effectiveness of stem cell transplantation.
ObjectiveTo review the research progress of endogenous repair strategy (ERS) in intervertebral disc (IVD).MethodsThe domestic and foreign literature related to ERS in IVD in recent years was reviewed, and its characteristics, status, and prospect in the future were summarized.ResultsThe key of ERS in IVD is to improve the vitality of stem/progenitor cells in IVD or promote its migration from stem cell Niche to the tissue that need to repair. These stem/progenitor cells in IVD are derived from nucleus pulposus, annulus fibrosus, and cartilaginous endplate, showing similar biological characteristics to mesenchymal stem cells including the expression of the specific stem/progenitor cell surface markers and gene, and also the capacity of multiple differentiations potential. However, the development, senescence, and degeneration of IVD have consumed these stem/progenitor cells, and the harsh internal microenvironment further impair their biological characteristics, which leads to the failure of endogenous repair in IVD. At present, relevant research mainly focuses on improving the biological characteristics of endogenous stem/progenitor cells, directly supplementing endogenous stem/progenitor cells, biomaterials and small molecule compounds to stimulate the endogenous repair in IVD, so as to improve the effect of endogenous repair.ConclusionAt present, ERS has gotten some achievements in the treatment of IVD degeneration, but its related studies are still in the pre-clinical stage. So further studies regarding ERS should be carried out in the future, especially in vivo experiments and clinical transformation.
Objective To summarize the research progress on rodent models of cervical spinal cord injury (SCI). Methods The relevant domestic and foreign literature in recent years was reviewed, the methods of establishing the rodent models of cervical SCI and the evaluation methods of behavior, imaging, neuroelectrophysiology, and histology were summarized. Results Cervical SCI involves primary and secondary injuries. Primary cervical SCI can be simulated with contusion, contusion compression, fracture dislocation, spinal cord traction, and spinal cord transection; scondary cervical SCI can be simulated with photochemical model and excitotoxicity model. Certain evaluation methods such as behavior, imaging, neuroelectrophysiology, and histology are used to evaluation during model building and research. Conclusion Different rodent models of cervical SCI have different advantages and application directions, and it is critical importance for the study of cervical SCI to establish effective animal models.
Objective To introduce growth and differentiation factor 5 (GDF-5) gene into hBMSCs using recombinant adenovirus vector and to investigate the effect of GDF-5 gene expression on hBMSCs osteogenic differentiation. Methods Recombinant adenovirus GDF-5 (Ad-GDF-5) containing green fluorescent protein (GFP) and Ad-GFP were amplifiedand tittered. hBMSCs at passage 3 were infected with two viruses at different titers. At 2 days after intervention, GFP expression was observed using fluorescence microscope, and GDF-5 expression in hBMSCs was detected by RT-PCR. Adherent hBMSCs at passage 3 were randomly divided into 4 groups: experimental group (GDF-5 gene transfection), osteogenic induction group, Ad- GFP infection group, and control group. Cell differentiation was detected by inverted phase contrast microscope observation, fluorescence microscope observation, reverse transcription fluorescence quantitative PCR, immunofluorescence staining, and von Kossa staining at different time points after intervention. Results The titer of Ad-GDF-5 and Ad-GFP was 1.0 × 109 pfu/mL and 1.2 × 109 pfu/mL, respectively. hBMSCs was efficiently infected by Ad-GDF-5 and Ad-GFP, and expressed target gene and GFP gene. At 1-7 days after intervention, morphology and growth pattern of the hBMSCs in the experimental group and the osteogenic induction group were transformed into osteoblast-l ike cells, whereas the cells in the other two groups were still maintained their original morphology and growth pattern. Reverse transcription fluorescence quantitative PCR detection: at 4 days after intervention, GDF-5 expression in the experimental group was obviously higher than that of other groups (P lt; 0.05); ALP, Col I, and OC gene expression in the experimental and the osteogenic induction group were superior to those of theAd-GFP infection and the control group (P lt; 0.05); Col I gene expression in the osteogenic induction group was greater than that of the experimental group (P lt; 0.05). Immunofluorescence staining: at 4 days after intervention, the cells in the osteogenic induction group and the experimental group expressed and secreted Col I, and no expression of Col I was evident in the other two groups. At 10 days after intervention, the cells in the osteogenic induction and the experimental group were positive for von Kossa staining, and the results of the other two groups were negative. Conclusion GDF-5 gene can be transferred into hBMSCs via adenovirus vector and be expressed stably. It can facil itate the osteogenic differentiation of the hBMSCs and lay a foundation for the further study of this kind of gene transferred hBMSCs effect on bone tissue repair.
Objective To compare the sequential efficacy of high-flow nasal cannula oxygen therapy (HFNC) with non-invasive mechanical ventilation (NIV). Methods Randomized controlled trials comparing the efficacy of NIV sequential invasive mechanical ventilation with HFNC were included in the Chinese Journal Full-text Database, VIP Journal database, Wanfang Database, Chinese Biomedical Literature Database, PubMed, Cochrane Library and Embase. Meta-analysis was performed using RevMan5.4 software. Results A total of 2404 subjects were included in 19 studies. Meta-analysis results showed that compared with NIV, HFNC had a statistically significant difference in reducing patients' re-intubation rate in invasive mechanical ventilation sequence [relative risk (RR)=0.65, 95% confidence interval (CI) 0.50 - 0.86, Z=3.10, P=0.002]. HFNC showed statistically significant difference compared with NIV in reducing lung infection rate (RR=0.40, 95%CI 0.21 - 0.79, Z=2.67, P=0.008). HFNC was significantly different from NIV in terms of length of stay in Intensive Care Unit (ICU) (MD=–5.77, 95%CI –7.64 - –3.90, Z=6.05, P<0.00001). HFNC was significantly different from NIV in improving 24 h oxygenation index (MD=13.16, 95%CI 8.77 - 17.55, Z=5.87, P<0.00001). There was no significant difference in ICU mortality between HFNC and NIV (RR=0.70, 95%CI 0.45 - 1.08, Z=1.61, P=0.11). Conclusion Compared with NIV, sequential application of HFNC in invasive mechanical ventilation can improve the reintubation rate and pulmonary infection rate to a certain extent, reduce the length of ICU stay and improve the 24 h oxygenation index, while there is no difference in ICU mortality, which is worthy of clinical application.