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OBJECTIVE: To explore clinical effect of arthroscopy-assisted rotator cuff tendon transfer in treating irreparable rotator cuff tears (IRCT). METHODS: From May 2015 to May 2018, 23 patients with unrepairable rotator cuff tears were treated with arthroscopy-assisted rotator cuff tendon transfer, and 21 patients were followed up finally, including 8 males and 13 females, aged from 48 to 82 years old with an average of(64.3±9.1) years old;the courses of disease ranged from 6 to 36 months with an average of (14.0±6.4) months. American Rotator and Elbow Surgeons Score(ASES) and Constant-Murley score were used to evaluate clinical efficacy before surgery and at the latest follow-up. RESULTS: All 21 patients were followed up for 36 to 54 months with an average of (39.4±4.4) months. Axillary incision of 1 patient was redness, swelling and exudation after surgery, which healed after 3 weeks of dressing change, and exudate culture was negative. At the latest follow-up, MRI showed partial tearing of the metastatic tendon in 2 patients, but pain and movement of the affected shoulder were still better than before surgery. ASES increased from preoperative (41.0±9.6) scores to the latest follow-up (75.6±14.0) scores, and had statistical difference (t=10.50, P<0.01). Constant-Murley score increased from (49.8±7.1) scores before operation to (67.5±11.6) scores at the latest follow-up (t=11.27, P<0.01). CONCLUSION: Arthroscopic assisted latissimus dorsalis tendon transposition restores physiological and anatomical structure of glenohumeral joint by reconstructing balance of horizontal and vertical couples of shoulder joint, thus achieving the stability of the shoulder joint, relieving shoulder pain and improving shoulder joint function.
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Lesões do Manguito Rotador , Articulação do Ombro , Músculos Superficiais do Dorso , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Lesões do Manguito Rotador/cirurgia , Manguito Rotador , Resultado do Tratamento , Articulação do Ombro/cirurgia , Transferência Tendinosa , Artroscopia , Amplitude de Movimento Articular/fisiologiaRESUMO
The evidential reasoning (ER) rule has been widely applied in the multiple attribute decision making (MADM), which makes the decision-making process transparent and credible by using a belief structure. To improve the ability of the ER rule in dealing with the interval uncertainty, a new interval ER (IER) rule is proposed in this article. The interval uncertainty is described as the interval grade in the new frame of discernment (FoD) to model the local ignorance. It is proved that the IER rule is a generalization of the ER rule. To study the influence of perturbation on the IER rule, the perturbation is first introduced to the belief structure, and the perturbation analysis (PA) is conducted for the IER rule. An optimization model is established to estimate the perturbation threshold, which can measure the effectiveness of the inference result under perturbation. Two numerical examples and a case study are carried out, respectively, to show the implementation process of the proposed IER rule and validate its effectiveness in different decision-making scenarios.
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PURPOSE: To study the effect of orthodontic treatment with extraction on root resorption and alveolar bone morphology of the central incisor in adult patients. METHODS: Eleven adult patients receiving orthodontic treatment were enrolled, and asked to take cone-beam CT(CBCT) scanning before and after treatment. Root resorption of the upper and lower central incisors after treatment, changes in alveolar bone thickness and height of alveolar bone were measured and compared. Statistical analysis was performed using SPSS 23.0 software package. RESULTS: The length of the tooth and root was reduced to a certain degree. The change in root length of the maxillary incisor was larger than that of the mandibular incisor. The alveolar bone width of the lingual and palatal neck of the central incisor showed some reduction, and alveolar bone width of the palatal neck of the upper central incisor and the middle lingual side of the mandibular central incisor changed to a certain extent. The width of the alveolar bone in the middle labial side of the mandibular central incisor increased, but the alveolar bone on the lingual and palatal side increased after orthodontic treatment, which was more obvious than that of the maxillary central incisor. CONCLUSIONS: Orthodontic treatment with tooth extraction is accompanied by a certain degree of root resorption of the central incisor and alveolar bone on the lingual and palatal side. However it is also accompanied by an increase in the amount of alveolar bone on the labial side. More fenestration and dehiscence are observed in the mandible.
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Incisivo , Reabsorção da Raiz , Adulto , Tomografia Computadorizada de Feixe Cônico , Humanos , Incisivo/diagnóstico por imagem , Mandíbula , Maxila/diagnóstico por imagemRESUMO
BACKGROUND: The lack of effective pharmacotherapies for nonalcoholic fatty liver disease (NAFLD) is mainly attributed to insufficient research on its pathogenesis. The pathogenesis of TM6SF2-efficient NAFLD remains unclear, resulting in a lack of therapeutic strategies for TM6SF2-deficient patients. AIM: To investigate the role of TM6SF2 in fatty acid metabolism in the context of fatty liver and propose possible therapeutic strategies for NAFLD caused by TM6SF2 deficiency. METHODS: Liver samples collected from both NAFLD mouse models and human participants (80 cases) were used to evaluate the expression of TM6SF2 by using western blotting, immunohistochemistry, and quantitative polymerase chain reaction. RNA-seq data retrieved from the Gene Expression Omnibus database were used to confirm the over-expression of TM6SF2. Knockdown and overexpression of TM6SF2 were performed to clarify the mechanistic basis of hepatic lipid accumulation in NAFLD. MK-4074 administration was used as a therapeutic intervention to evaluate its effect on NAFLD caused by TM6SF2 deficiency. RESULTS: Hepatic TM6SF2 levels were elevated in patients with NAFLD and NAFLD mouse models. TM6SF2 overexpression can reduce hepatic lipid accumulation, suggesting a protective role for TM6SF2 in a high-fat diet (HFD). Downregulation of TM6SF2, simulating the TM6SF2 E167K mutation condition, increases intracellular lipid deposition due to dysregulated fatty acid metabolism and is characterized by enhanced fatty acid uptake and synthesis, accompanied by impaired fatty acid oxidation. Owing to the potential effect of TM6SF2 deficiency on lipid metabolism, the application of an acetyl-CoA carboxylase inhibitor (MK-4074) could reverse the NAFLD phenotypes caused by TM6SF2 deficiency. CONCLUSION: TM6SF2 plays a protective role in the HFD condition; its deficiency enhanced hepatic lipid accumulation through dysregulated fatty acid metabolism, and MK-4074 treatment could alleviate the NAFLD phenotypes caused by TM6SF2 deficiency.
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Hepatopatia Gordurosa não Alcoólica , Animais , Ácidos Graxos/metabolismo , Humanos , Metabolismo dos Lipídeos/genética , Lipídeos , Fígado/patologia , Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Hepatopatia Gordurosa não Alcoólica/etiologia , Hepatopatia Gordurosa não Alcoólica/genéticaRESUMO
OBJECTIVE: This study was designed to investigate the role of the nucleotide-binding-domain -and leucine-rich repeat -containing (NLR) family, pyrin-domain-containing 3 (NLRP3) inflammasome in the pathogenesis of polymyositis (PM). METHODS: Immunochemistry was performed to analyze the NLRP3, caspase-1 and interleukin-1 beta (IL-1ß) expression in the muscle tissue of PM patients. Rat model of PM and C2C12 cell were used to investigate the potential role of NLRP3 inflammasome in PM. RESULTS: The percentage of CD 68+ macrophages, and the expression levels of NLRP3, caspase-1 and IL-1ß in the muscle tissue were elevated in 27 PM patients. LPS/ATP treatment resulted in activation of NLRP3 inflammasome and secretion of IL-1ß as well as interferons (IFNs) and monocyte chemotactic protein-1 (MCP-1) in the Raw 264.7 macrophages. Meanwhile, LPS/ATP challenged activation of NLRP3 inflammasome induced overexpression of major histocompatibility complex class I (MHC-I), a key molecular of PM in the co-cultured C2C12 cells. The effect was decreased by treatment of NLRP3 inflammasome inhibitor MCC950 or siRNA of NLRP3 inflammasome. These findings suggested certain levels of IL-1ß rather than IFNs up-regulated MHC-I expression in C2C12 cells. IL-1ß blockade using neutralizing IL-1ß monoclonal antibody or siRNA of IL-1ß suppressed MHC-I overexpression. In vivo, NLRP3 inflammasome inhibition by MCC950 reduced the expression of NLRP3, IL-1ß and MHC-I in the muscle tissue of PM modal rats. Also, it attenuated the intensity of muscle inflammation as well as the CRP, CK, and LDH levels in the serum. CONCLUSION: NLRP3/caspase-1/IL-1ß axis may play an important role in the development of PM. Inhibition of NLRP3 activation may hold promise in the treatment of PM.
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Inflamassomos , Polimiosite , Trifosfato de Adenosina , Animais , Caspase 1/genética , Caspase 1/metabolismo , Inflamassomos/metabolismo , Lipopolissacarídeos , Complexo Principal de Histocompatibilidade , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Polimiosite/genética , RNA Interferente Pequeno , Ratos , Regulação para CimaRESUMO
Evidential reasoning (ER) rule has been widely used in dealing with uncertainty. As an important parameter to measure the inherent property of evidence, the evidence reliability makes the ER rule constitute a generalized reasoning framework. In current research of the ER rule, the evidence reliability tends to be expressed in the form of quantitative value by certain methods or expert knowledge. The single quantitative value lacks the ability to describe the statistical property of reliability, which leads to unreasonable results. In this article, a new ER rule with continuous probability distribution of reliability denoted by ERr-CR is proposed. The combination of two pieces of evidence is discussed in detail, where the reliability is profiled as random variables with specific probability distribution. To characterize the output of ERr-CR, a novel concept of expectation of the expected utility is proposed. In addition, the ERr-CR is expanded to multiple pieces of evidence to show its universality. Further, the basic performances of the ERr-CR are explored to illustrate the rationality. Moreover, a case study of safety assessment of natural gas storage tanks (NGSTs) is conducted to show the potential applications of ERr-CR, which makes the proposed method more practical.
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Projetos de Pesquisa , Probabilidade , Reprodutibilidade dos TestesRESUMO
The patient had suffered from both proximal and distal limb weakness since her early childhood, without the involvement of ocular or respiratory muscles. Repetitive nerve stimulation (RNS) at 3 Hz showed significant decrement in the area and amplitude of the compound muscle action potential (CMAP) on the right abductor digiti minimi (26%) and trapezius (17%). Whole-exon sequencing revealed two novel heterozygous mutations (p.Q1406Rfs*29 and p.R1521H) in the LG1 domain of agrin, which were deemed likely pathogenic for congenital myasthenic syndromes (CMS) according to a bioinformatics analysis. The patient showed remarkable improvement after treatment with salbutamol. This case expanded the mutation spectrum of AGRN.
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Agrina , Síndromes Miastênicas Congênitas , Agrina/genética , Pré-Escolar , Éxons , Feminino , Humanos , Debilidade Muscular , Mutação/genética , Síndromes Miastênicas Congênitas/genética , Síndromes Miastênicas Congênitas/patologiaRESUMO
In current studies of safety assessment for complex systems with the evidential reasoning (ER) rule, the evidence reliability is generally given by experts, which makes the observation data by sensors ignored. However, sensors are inevitably affected by such various uncertainties as perturbations in engineering practice, which can reduce their quality and tracking ability. As such, the observation data may become unreliable, and the modeling accuracy of the ER rule is decreased. In this article, a new ER rule-based safety assessment method with sensor reliability for complex systems is proposed, where sensor reliability and perturbation are considered. The coefficient of the variation-based weighting (CVBW) method is employed to obtain sensor weight. The sensor reliability is calculated by static reliability and dynamic reliability, which are determined by experts and the distance-based method, respectively. The perturbation is quantified as a bounded parameter defined as the perturbation factor, which is used to describe uncertainties and aggregate static reliability and dynamic reliability. The performance analysis of safety assessment is conducted to demonstrate the rationality of perturbation and position poor sensors, followed by a safety assessment algorithm. A case study is carried out to validate the effectiveness of the proposed method.
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Algoritmos , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To compare the clinical effect between yin-yang penetrating acupuncture with elongated needle and routine acupuncture for spastic limb dysfunction after stroke. METHODS: A total of 60 patients were randomized into an observation group and a control group, 30 cases in each group. Both groups received basic treatment, yin-yang penetrating acupuncture with elongated needle was applied from Yanglingquan (GB 34) to Xuanzhong (GB 39), Quchi (LI 11) to Wenliu (LI 7), Huantiao (GB 30) to Fengshi (GB 31), Jianyu (LI 15) to Quchi (LI 11), etc. on the affected side in the observation group; routine acupuncture was applied at Neiguan (PC 6), Shuigou (GV 26), Sanyinjiao (SP 6), Jiquan (HT 1), Chize (LU 5), Weizhong (BL 40), Jianyu (LI 15), etc. on the affected side in the control group. Once a day, 5 times a week, 2 weeks as a course, 2 courses were required in the two groups. Before and after treatmentï¼the modified Ashworth scale (MAS) grade, Fugl-Meyer assessment scale (FMA) score, activity of daily living scale (ADL) (Barthel index) score were observed, and the clinical effect was evaluated in the two groups. RESULTS: Compared before treatment, the MAS grade after treatment was improved in the two groups (P<0.05), that in the observation group was superior to the control group (P<0.05). Compared before treatment, the FMA and ADL scores after treatment were increased in the two groups (P<0.05), the changes in the observation group were larger than the control group (P<0.05). The total effective rate in the observation group was 80.0% (24/30), which was superior to 70.0% (21/30) in the control group (P<0.05). CONCLUSION: Yin-yang penetrating acupuncture with elongated needle could improve muscle tension, spasm grade and motor function in patients with spastic limb dysfunction after stroke, enhance the activity of daily living, its clinical effect is superior to routine acupuncture.
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Terapia por Acupuntura , Acidente Vascular Cerebral , Pontos de Acupuntura , Humanos , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Yin-YangRESUMO
ABSTRACT: Although transforaminal lumbar interbody fusion (TLIF) is a widely accepted procedure, major complications such as cage retropulsion (CR) can cause poor clinical outcomes. Endplate injury (EI) was recently identified as a risk factor for CR, present in most levels developing CR. However, most EIs occurred in non-CR levels, and the features of EIs in CR levels remain unknown.The aim of this study was to identify risk factors for CR following TLIF; in particular, to investigate the relationship between EIs and CR, and to explore the features of EIs in CR.Between October 2010 and December 2016, 1052 patients with various degenerative lumbar spinal diseases underwent bilateral instrumented TLIF. Their medical records, radiological factors, and surgical factors were reviewed and factors affecting the incidence of CR were analyzed.Twenty-one patients developed CR. Nine had back pain or leg pain, of which six required revision surgery. A pear-shaped disc, posterior cage positioning and EI were significantly correlated with CR (Pâ<â.001, Pâ=â.001, and Pâ<â.001, respectively). Computed tomography (CT) scans revealed the characteristics of EIs in levels with and without CR. The majority of CR levels with EIs exhibited apparent compression damage in the posterior part of cranial endplate on the decompressed side (17/18), accompanied by caudal EIs isolated in the central portion. However, in the control group, the cranial EIs involving the posterior part was only found in four of the total 148 levels (Pâ<â.001). Most of the injuries were confined to the central portion of the cranial or caudal endplate or both endplates (35 in 148 levels, 23.6%). Additionally, beyond cage breaching into the cortical endplate on lateral radiographs, a characteristic appearance of coronal cage misalignment was found on AP radiographs in CR levels with EIs.A pear-shaped disc, posterior cage positioning and EI were identified as risk factors for CR. EI involving the posterior epiphyseal rim had influence on the development of CR. Targeted protection of the posterior margin of adjacent endplates, careful evaluation of intraoperative radiographs, and timely remedial measures may help to reduce the risks of CR.
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Fixadores Internos/efeitos adversos , Vértebras Lombares , Complicações Pós-Operatórias , Falha de Prótese/efeitos adversos , Fusão Vertebral , Espondilolistese , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Radiografia/métodos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Medição de Risco/métodos , Fatores de Risco , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgiaRESUMO
This study aims to compare the levels of NLRP3 inflammasome and its related cytokines (IL-1ß, IL-6, and IL-17), in serum and cerebrospinal fluid (CSF) of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), non-inflammatory chronic polyneuropathy, and functional neurological disorders. The results showed elevated NLRP3 inflammasome, IL-1ß, IL-6, and IL-17 levels in serum but not in CSF of CIDP, compared to the other groups. Moreover, there was a positive correlation between NLRP3 inflammasome level and each cytokine. We also found a positive correlation between serum NLRP3 inflammasome level and disease severity in CIDP patients. Taken together, these results suggested that NLRP3 inflammasome could act as a potential biomarker to diagnose CIDP and assess the severity of the disease.
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Inflamassomos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Citocinas , Humanos , Interleucina-1beta , Proteína 3 que Contém Domínio de Pirina da Família NLR , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: Turnover of cartilage endplate extracellular matrix (ECM) may play an important role in disc degeneration and low back pain (LBP). However, the expression pattern of pro-inflammatory factors, matrix metalloproteinases (MMP), and tissue inhibitors of metalloproteinases (TIMP) in the cartilage endplates (CEP) of intervertebral discs (IVD) is not understood. We aimed to examine the transcriptional levels of MMP, TIMP, and interleukins (IL), and the correlations between them. METHODS: Thirty degenerated cartilage endplate samples from patients with LBP who underwent lumbar fusion surgery were included in the degenerated group. Ten patients without LBP history who underwent lumbar surgery because of vertebral burst fractures were included in the control group. The degenerative severity of the samples was evaluated by MRI, and hematoxylin-eosin and safranin O-fast green (SO-FG) staining. Real-time polymerase chain reaction (RT-PCR) was used to detect the mRNA levels of MMP-1, MMP-3, MMP-9, MMP-13, TIMP-1, TIMP-2, TIMP-3, IL-1α, IL-1ß, and IL-6. The correlations between the levels of these genes were tested using Spearman's rho test. RESULTS: Hematoxylin-eosin and SO-FG staining confirmed a decrease in cell number and proteoglycans in the degenerated cartilage endplate. MRI showed significant signal changes in degenerated cartilage endplates. Patients in the degenerated group showed a higher rate of endplate Modic changes when compared with the control group. MMP-3, MMP-9, TIMP-3, IL-1α, and IL-1ß were elevated with statistical significance, while MMP-1, MMP-13, TIMP-1, TIMP-2, and IL-6 were changed without statistical significance or remained unchanged. Expression of MMP-3 was positively correlated with IL-1α (Spearman coefficient, 0.486; P < 0.05); expression of TIMP-3 was positively correlated with MMP-9, IL-1α, and IL-1ß (Spearman coefficient, 0.577, 0.407, and 0.571, respectively; P < 0.05). CONCLUSION: MMP-3, MMP-9, TIMP-3, IL-1α, and IL-1ß may play a role in the process of cartilage endplate degeneration. MMP-3 may be regulated by IL-1α, and TIMP-3 might be associated with MMP-9 and regulated by IL-1α and IL-1ß.
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Cartilagem/metabolismo , Interleucinas/metabolismo , Degeneração do Disco Intervertebral/metabolismo , Metaloproteinases da Matriz/metabolismo , Inibidores Teciduais de Metaloproteinases/metabolismo , Adulto , Cartilagem/diagnóstico por imagem , Matriz Extracelular/metabolismo , Feminino , Regulação da Expressão Gênica , Humanos , Mediadores da Inflamação/metabolismo , Interleucinas/genética , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/metabolismo , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Imageamento por Ressonância Magnética , Masculino , Metaloproteinases da Matriz/genética , Pessoa de Meia-Idade , RNA Mensageiro/genética , Radiografia , Fusão Vertebral , Inibidores Teciduais de Metaloproteinases/genéticaRESUMO
OBJECTIVE: To compare postoperative imaging results, clinical outcomes and complications between the multifidus muscle bundle (MMB) approach and the conventional open (CO) approach in one-level posterior lumbar interbody fusion (PLIF). METHODS: Based on the inclusion and exclusion criteria, 201 of 351 patients in our hospital were enrolled in this prospective study and underwent MMB-PLIF or CO-PLIF randomly: 111 patients in the MMB-PLIF group and 90 patients in the CO-PLIF group. A total of 100 patients failed to be followed up in the following 7-9 years. Therefore, in this study, 52 patients of the MMB group and 49 patients of the CO group were included. We evaluated the differences in terms of multifidus atrophy rate, intervertebral disc height and segmental lordosis restoration of the operation segment, lumbar lordosis restoration, fusion rate, visual analogue scale (VAS) for back and leg pain, Oswestry disability index (ODI), complication rates, and patient satisfaction rates between the two groups. Correlation between multifidus muscle degeneration and the incidence of complications was investigated, and we compared the multifidus muscle degeneration rate between patients with or without intractable back pain or adjacent segment degeneration. RESULTS: There were no significant differences in age, sex, body mass index (BMI), diagnosis, segments distribution, and mean follow-up time between the MMB-PLIF group and the CO-PLIF group. In addition, no differences regarding sex, age, or BMI were found between the lost follow-up group and the successful follow-up group. In regard to imaging and clinical evaluation, at the final follow-up, there were significant differences in multifidus atrophy rates (27.0% ± 6.8% vs 38.7% ± 10.9%), lumbar lordosis restoration (4.6° ± 2.5° vs 3.0° ± 1.9°), postoperative VAS for back pain (1.1 ± 0.9 vs 1.8 ± 1.2), ODI (7.7 ± 5.0 vs 12.4 ± 6.7), and patient satisfaction rates (86.5% vs 61.2%) between MMB-PLIF and CO-PLIF groups. However, there were no significant differences in segmental lordosis, intervertebral height restoration, postoperative VAS for leg pain or fusion rate between the two groups. In regards to complications, there were significant differences in the incidence of adjacent segment degeneration (3.8% vs 14.3%), intractable back pain (3.8% vs 22.4%), and residual neurological symptoms (5.8% vs 20.4%) between the two groups (P < 0.05) at the final follow-up. In addition, patients with adjacent segment degeneration and intractable back pain were observed with more significant multifidus muscle atrophy than those without these two complications (31.9% ± 1.1% vs 39.6% ± 2.1% and 30.9% ± 1.1% vs 42.8% ± 2.1%). CONCLUSION: Compared with CO-PLIF, MMB-PLIF had advantages in relation to protection of the multifidus muscle, better maintenance of lumbar lordosis, reduced lower back pain and ODI score, fewer complications, and a higher patient satisfaction rate. Protection of the multifidus muscle in lumbar surgery is an important aspect of minimally invasive surgery.
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Vértebras Lombares/cirurgia , Músculos Paraespinais/cirurgia , Fusão Vertebral/métodos , Idoso , Dor nas Costas/etiologia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/etiologia , Medição da Dor/métodos , Satisfação do Paciente , Parafusos Pediculares , Complicações Pós-Operatórias , Estudos Prospectivos , Radiografia , Fusão Vertebral/efeitos adversosRESUMO
OBJECTIVES: To assess the prevalence and related factors of benign paroxysmal positional vertigo (BPPV) in patients with spontaneous intracranial hypotension (SIH). METHODS: We retrospectively reviewed 156 consecutive inpatients with SIH, and collected the clinical and radiological data. These patients were divided into BPPV group and non-BPPV group according to the clinical manifestation and the results of Dix-Hallpike or supine roll tests during hospitalization period. We performed a univariate analysis and a further multiple logistic regression analysis to identify the related factors of the development of BPPV in SIH patients. RESULTS: BPPV was detected in 18 patients among the total 156 SIH patients (11.54%). The univariate analysis showed a low cerebrospinal fluid (CSF) pressure (P = 0.018), a small pontomesencephalic angle (P = 0.012) and a positive venous distension sign (VDS) (P = 0.045) were associated with the presence of BPPV. But the multivariate analysis only demonstrated a low CSF pressure was related to the presence of BPPV (OR = 1.022, 95% CI: 1.001-1.043, P = 0.044). CONCLUSION: BPPV is common in SIH patients. SIH patients with low CSF pressure may be prone to develop BPPV.
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Vertigem Posicional Paroxística Benigna/etiologia , Hipotensão Intracraniana/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vertigem Posicional Paroxística Benigna/diagnóstico por imagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Hipotensão Intracraniana/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: To analyze the early complications and causes of oblique lateral interbody fusion, and put forward preventive measures. METHODS: There were 235 patients (79 males and 156 females) analyzed in our study from October 2014 to May 2017. The average age was 61.9 ± 0.21 years (from 32 to 83 years). Ninety-one cases were treated with oblique lateral interbody fusion (OLIF) alone (OLIF alone group) and 144 with OLIF combined with posterior pedicle screw fixation through the intermuscular space approach (OLIF combined group). In addition, 137/144 cases in the combined group were primarily treated by posterior pedicle screw fixation, while the treatments were postponed in 7 cases. There were 190 cases of single fusion segments, 11 of 2 segments, 21 of 3 segments, and 13 of 4 segments. Intraoperative and postoperative complications were observed. RESULTS: Average follow-up time was 15.6 ± 7.5 months (ranged from 6 to 36 months). Five cases were lost to follow-up (2 cases from the OLIF alone group and 3 cases from the OLIF combined group). There were 7 cases of vascular injury, 22 cases of endplate damage, 2 cases of vertebral body fracture, 11 cases of nerve injury, 18 cases of cage sedimentation or cage transverse shifting, 3 cases of iliac crest pain, 1 case of right psoas major hematoma, 2 cases of incomplete ileus, 1 case of acute heart failure, 1 case of cerebral infarction, 3 case of left lower abdominal pain, 9 cases of transient psoas weakness, 3 cases of transient quadriceps weakness, and 8 cases of reoperation. The complication incidence was 32.34%. Thirty-three cases occurred in the OLIF alone group, with a rate of 36.26%, and 43 cases in the group of OLIF combined posterior pedicle screw fixation, with a rate of 29.86%. Fifty-seven cases occurred in single-segment fusion, with a rate of 30.0% (57/190), 4 cases occurred in two-segment fusion, with a rate of 36.36% (4/11), 9 cases occurred in three-segment fusion, with a rate of 42.86% (9/21), and 6 cases occurred in four-segment fusion, with a rate of 46.15% (6/13). CONCLUSION: In summary, OLIF is a relatively safe and very effective technique for minimally invasive lumbar fusion. Nonetheless, it should be noted that OLIF carries the risk of complications, especially in the early stage of development.
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Vértebras Lombares/cirurgia , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/prevenção & controle , Parafusos Pediculares , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X , Traumatismos do Sistema Nervoso/etiologia , Traumatismos do Sistema Nervoso/prevenção & controle , Lesões do Sistema Vascular/etiologiaRESUMO
Extracellular matrix (ECM) degrading enzymes, including matrix metalloproteinases (MMPs), are critical for cartilage destruction in the progression of osteoarthritis (OA). Thus, identifying novel drugs, which suppress the synthesis of MMPs may facilitate the treatment of OA. The cytotoxicity of lycorine was determined using a CCK8 assay. The effects of lycorine on IL1ßinduced upregulation of MMPs and activation of mitogenactivated protein kinase pathways were detected by western blot analysis and reverse transcriptionquantitative polymerase chain reaction. Hematoxylin and eosin staining and Safranin O staining were used to evaluate the effect of lycorine in a mouse anterior cruciate ligament transection model. In the present study, it was demonstrated for the first time, to the best of our knowledge, that lycorine (LY) suppressed interleukin1ß (IL1ß)induced synthesis of MMP3 and MMP13 in vitro. Molecular analysis revealed that LY abrogated the phosphorylation of cJun Nterminal kinase (JNK) and the activation of the nuclear factor (NF)κB signaling pathway caused by IL1ß stimulation. In addition, in vivo experiments in a mouse anterior cruciate ligament transection model confirmed the protective role of LY on cartilage. Taken together, the data obtained in the present study demonstrated that LY suppressed the IL1ßinduced expression of MMP3 and MMP13 through inhibition of the JNK and NFκB pathways, suggesting that LY may be used as a potential drug for the treatment of OA.
Assuntos
Alcaloides de Amaryllidaceae/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Condrócitos/efeitos dos fármacos , Interleucina-1beta/imunologia , Metaloproteinase 13 da Matriz/imunologia , Metaloproteinase 3 da Matriz/imunologia , Osteoartrite/tratamento farmacológico , Fenantridinas/uso terapêutico , Substâncias Protetoras/uso terapêutico , Amaryllidaceae/química , Alcaloides de Amaryllidaceae/química , Alcaloides de Amaryllidaceae/farmacologia , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/farmacologia , Cartilagem Articular/efeitos dos fármacos , Cartilagem Articular/imunologia , Cartilagem Articular/patologia , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Condrócitos/imunologia , Condrócitos/patologia , Modelos Animais de Doenças , Masculino , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/imunologia , Osteoartrite/imunologia , Osteoartrite/patologia , Fenantridinas/química , Fenantridinas/farmacologia , Substâncias Protetoras/química , Substâncias Protetoras/farmacologia , Ratos , Ratos Sprague-DawleyRESUMO
Intervertebral disc degeneration is a major cause of low back pain. The nucleus pulposus (NP) is an important intervertebral disc component. Recent studies have shown that carbonic anhydrase 12 (CA12) is a novel NP marker. However, the mechanism by which CA12 is regulated and its physiological function are unclear. In our study, CA12, hypoxia-inducible factor 1α (HIF-1α) and HIF-2α expression levels were examined in 81 human degenerated NP samples using real-time RT-PCR, immunohistochemistry and western blot. Rat NP cells were cultured in a hypoxic environment, and hypoxia-induced CA12 expression was examined. Rat NP cells were treated with HIF-1α siRNA or the prolyl hydroxylase (PHD) inhibitor dimethyloxalylglycine (DMOG) to evaluate the role of PHD/HIF-1 in regulating CA12 expression. Rat NP cells were treated with CA12 siRNA to determine the function of CA12. A rat ex vivo model was established to confirm that PHD, HIF-1, and CA12 have important roles in disc degeneration. We found that CA12 was significantly downregulated in degenerated human NP samples at the mRNA and protein levels. CA12 expression sharply increased by ~30-fold in response to hypoxia. The expression of HIF-1α, but not HIF-2α, also decreased in degenerated human NP samples and was positively correlated with CA12 expression. HIF-1α knockdown under hypoxia reduced the CA12 mRNA and protein expression levels. DMOG treatment increased HIF-1α and CA12 expression. CA12 knockdown significantly inhibited anabolic protein expression, whereas catabolic enzymes remained unchanged. The ex vivo experiments supported our in vitro studies of the role of PHD/HIF-1/CA12. In conclusion, CA12 is downregulated in degenerated NPs, and its expression may be regulated by the PHD/HIF-1 axis. Decreased CA12 expression may lead to decreased extracellular matrix synthesis, which contributes to degenerative disc disease progression.
Assuntos
Anidrases Carbônicas/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Degeneração do Disco Intervertebral/metabolismo , Degeneração do Disco Intervertebral/prevenção & controle , Prolil Hidroxilases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo , Anidrases Carbônicas/genética , Hipóxia Celular/genética , Hipóxia Celular/fisiologia , Células Cultivadas , Feminino , Técnicas de Silenciamento de Genes , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/antagonistas & inibidores , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Degeneração do Disco Intervertebral/genética , Masculino , Pessoa de Meia-Idade , Núcleo Pulposo/citologia , Núcleo Pulposo/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley , Regulação para Cima , Adulto JovemRESUMO
A tracked vehicle has been widely used in exploring unknown environments and military fields. In current methods for suiting soil conditions, soil parameters need to be given and the traction performance cannot always be satisfied on soft soil. To solve the problem, it is essential to estimate track-soil parameters in real-time. Therefore, a detailed mathematical model is proposed for the first time. Furthermore, a novel algorithm which is composed of Kalman filter (KF) and improved strong tracking filter (STF) is developed for online track-soil estimation and named as KF-ISTF. By this method, the KF is used to estimate slip parameters, and the ISTF is used to estimate motion states. Then the key soil parameters can be estimated by using a suitable soil model. The experimental results show that equipped with the estimation algorithm, the proposed model can be used to estimate the track-soil parameters, and make the traction performance satisfied with soil conditions.
RESUMO
Osteoclasts play an important role in diseases involving bone loss. In this study, we assessed the effect of a plant-derived natural alkaloid (lycorine, or LY) on osteoclastogenesis in vitro and in vivo. Our in vitro study showed that receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclastogenesis could be inhibited by LY; this effect was due to inhibition of mitogen-activated protein kinase (MAPK) signalling via MAP kinase kinases (MKKs). The MAPK agonist anisomycin could partially rescue the inhibitory effect of LY. Furthermore, LY also played a protective role in both a murine ovariectomy (OVX)-induced osteoporosis model and a titanium particle-induced osteolysis model. These results confirmed that LY was effective in preventing osteoclast-related diseases in vivo. In conclusion, our results show that LY is effective in suppressing osteoclastogenesis and therefore could be used to treat OVX-induced osteoporosis and wear particle-induced osteolysis.
Assuntos
Alcaloides de Amaryllidaceae/farmacologia , Conservadores da Densidade Óssea/farmacologia , Osteogênese/efeitos dos fármacos , Osteólise/prevenção & controle , Osteoporose/prevenção & controle , Fenantridinas/farmacologia , Ligante RANK/genética , Animais , Medula Óssea/efeitos dos fármacos , Diferenciação Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Modelos Animais de Doenças , Feminino , Regulação da Expressão Gênica , MAP Quinase Quinase 4/genética , MAP Quinase Quinase 4/metabolismo , MAP Quinase Quinase 7/genética , MAP Quinase Quinase 7/metabolismo , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Macrófagos/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Osteoclastos/efeitos dos fármacos , Osteoclastos/metabolismo , Osteoclastos/patologia , Osteólise/induzido quimicamente , Osteólise/genética , Osteólise/patologia , Osteoporose/genética , Osteoporose/metabolismo , Osteoporose/patologia , Ovariectomia , Cultura Primária de Células , Ligante RANK/antagonistas & inibidores , Ligante RANK/metabolismo , Transdução de Sinais , TitânioRESUMO
STUDY DESIGN: A transcriptional expression assessment of human samples. OBJECTIVE: To evaluate 12 new candidate nucleus pulposus (NP) markers in degenerative disc disease in a Chinese population. SUMMARY OF BACKGROUND DATA: Disc degeneration is a major contributor of low back pain. However, no specific and reliable markers of degeneration of NP are available. METHODS: Specimens of NP were collected from 81 patients and grouped into the degenerated disc group (undergoing discectomy and fusion with significant signs of disc degeneration) and the trauma control group (undergoing anterior vertebral body and disc excision and fusion without signs of disc degeneration). Lumbar spine magnetic resonance imaging, hematoxylin-eosin staining, and safranin O staining of sections of NP tissues were conducted to evaluate the severity of the disc degeneration in all samples. Quantitative reverse transcription polymerase chain reaction was performed to investigate the levels of mRNA expression of these genes, as well as those of aggrecan, type II collagen, and SRY-box 9 (SOX-9). Degenerated samples were also divided into groups according to Pfirrmann grading system to elucidate the association of severity of degeneration and gene transcriptional levels. We also tested the relationship between mRNA levels of these genes and clinical characteristics such as hypertension and diabetes mellitus. RESULTS: We demonstrated that 11 of the 12 candidates showed significant differential expression in degenerated discs. Changes in the expression of these 11 genes were determined to be risk factors in degenerative disc diseases. The expression of neurochondrin (NCDN), keratin 8 (KRT8), and matrix Gla protein (MGP) even showed significant changes among subgroups of patients with degenerative disc disease stratified according to the Pfirrmann grading system. The expression of keratin 18 (KRT18), cadherin 2 (CDH2), synaptosomal-associated protein 25 (SNAP25), KRT8, and NCDN was significantly decreased in patients with hypertension. In contrast, the expression of MGP and cartilage oligomeric matrix protein was significantly upregulated in patients with diabetes mellitus. CONCLUSION: Overall, we demonstrated the clinical utility of 11 novel NP markers for degenerative disc disease. Among them, the expression of NCDN, KRT8, and MGP may indicate the severity of disc degeneration. LEVEL OF EVIDENCE: N/A.