Compression therapy following posterior lumbar interbody fusion: a prospective, randomized, clinical study.

BACKGROUND: Wound-related complications are an inevitable issue faced by spinal surgeons. Negative pressure drainage remains the most commonly used method to prevent postoperative hematoma and related complications. This prospective, randomized, controlled study was conducted to evaluate the efficacy of compression therapy following posterior lumbar interbody fusion, with emphasis on pain, anemia, and inflammation. METHODS: Sixty consecutive patients who have undergone posterior lumbar interbody fusion in the age range 43-78 years, with an average age of 59 years, were selected and randomly assigned into two groups. Factors, such as drainage volume, visual analog scale (VAS) pain score for back pain, white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (Hb) levels, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels assessed on the 1st, 3rd, and 10th days postoperatively, were compared between the two groups. RESULTS: The average follow-up was 6 months, ranging from 3 to 11 months. Drainage volume, VAS score, and CRP levels on the 10th day after the surgery were found to be significantly lower in the treatment group than in the control group. RBC count and Hb levels on the 3rd and 10th postoperative days were observed to be significantly higher in the treatment group than in the control group (P < 0.05). During discharge, the wounds of the patients of the both groups had healed and neither showed any symptoms of infection, hematoma, or necrosis. CONCLUSION: Compression therapy relieves pain, alleviates anemia, and the inflammatory response following posterior lumbar interbody fusion. TRIAL REGISTRATION: ChiCTR1800015825 on chictr.org.cn, April 23, 2018, the trial registry is Chinese Clinical Trial Registry.

Morphology of the human xiphoid process: dissection and radiography of cadavers and MDCT of patients.

PURPOSE: The purpose of this study was to evaluate the morphology of xiphoid process by dissection and using radiography of cadavers and multidetector computed tomography (MDCT) in patients. METHODS: The xiphoid processes of 41 cadavers were dissected and taken by radiography. Other 902 patients examined by MDCT were revealed by image post-processing used with multiple planar reconstruction, maximum intensity projection and volume rendering. RESULTS: Xiphoid processes displayed pointed shape in 422 cases (44.75 %), oval shape in 387 cases (41.04 %), and forked shape in 134 cases (14.21 %). The sagittal shape of the xiphoid process was observed as ventrally deviated in 217 cases (23.01 %), dorsally deviated in 191 cases (20.25 %), S-shaped (ahead ventral, then dorsal) in 21 cases (2.23 %), and resembling a hook in 14 of ventral deviated patients and in 19 of those dorsal deviated patients. The foramen of xiphoid processes was found in 544 cases (57.69 %). The pattern L (a large foramen with a diameter of more than 5 mm) appeared in 302 cases (55.51 %), pattern S (a small foramen with a diameter of no more than 5 mm) in 155 cases (28.49 %), pattern LS (a mixture of a large and a small foramina) in 37 cases (6.80 %), and pattern SS (two or more small foramina) in 50 cases (9.19 %). CONCLUSION: Human xiphoid process appeared in morphological diversity. The anatomic structure and ossification degree of xiphoid process was well evaluated by MDCT. Our data may be used for diagnosis and surgical treatment of xiphoid process-related diseases.

Fetal intrahepatic gallbladder and topographical anatomy of the liver hilar region and hepatocystic triangle.

The fetal gallbladder (GB) is embedded in a deep fossa surrounded by the liver parenchyma. Using 15 specimens with intrahepatic GB (crown-rump length 45-92 mm; approximately 9-13 weeks of gestation), we assessed the fetal topographical anatomy of the hepatocystic triangle and the porta hepatis. The cystic duct displayed a long upward course (0.9-4.5 mm along the supero-inferior axis) from the GB, along the duodenum, to the common bile duct in the hepatoduodenal ligament, via an independent mesentery separated from liver parenchyma by a recess of the peritoneal cavity. Notably, the course varied in length among specimens, not among stages. At the porta hepatis, we were able to distinguish the supraportal course of the posterior right hepatic duct overriding a portal vein branch to segment 8 (6/15) from the other, infraportal course (9/15). In the latter type, the portal vein bifurcation was superior to the cystic duct course. Two margins of the hepatocyctic triangle were very long in fetuses because of the inferiorly located intrahepatic GB. Thus, the triangle seems to be difficult to identify in prenatal ultrasound. During changes in location after 9 weeks, the GB fundus remains attached to the liver because the cystic artery was often embedded in the liver parenchyma. A failure in the embedding and re-exposure process of the GB may result in anomalous peritoneal folds around the GB.

[Clinical observation of chiropractic manipulation in the treatment of degenerative scoliosis].

OBJECTIVE: To observe clinical efficacy of chiropractic manipulation in the treatment of degenerative scoliosis (DS). METHODS: From June 2017 to September 2019, 120 patients with degenerative scoliosis were randomly divided into treatment group (60 cases) and control group(60 cases). The patients in treatment group were treated with chiropractic manipulation once every other day for 4 weeks. The patients in control group were treated with eperisone hydrochloride tablets combined with thoracolumbar orthopedic(TSLO)brace, oral eperisone hydrochloride tablets 50 mg three times a day, wearing TSLO brace for not less than 8 hours a day. The course of treatment was 4 weeks. After the patients were selected into the group, visual analogue scale (VAS) and Oswestry Disability Index (ODI) were recorded before treatment, 1, 2, 3, 4 weeks after treatment and 1 month after treatment. The full length X-ray of the spine was taken before and 4 weeks after treatment, and the scoliosis Cobb angle, sagittal vertical axis (SVA) and lumbar lordosis (LL) were measured and compared. The adverse reactions during the treatment were recorded. RESULTS: There were significant differences in VAS and ODI between two groups at each time point after treatment (P<0.001), VAS and ODI at 2 weeks after treatment (PVAS=0.025, PODI=0.032) and 3 weeks after treatment(PVAS=0.040, PODI=0.044) in treatment group were significantly different from those in control group, but there was no significant difference in VAS and ODI at other time points between treatment group and control group (P>0.05). There was significant difference in Cobb angle between treatment group(P=0.010) and control group(P=0.017) after treatment, but there was no significant difference in LL and SVA between treatment group and control group. There was no significant difference in Cobb angle, LL and SVA between two groups before and after treatment. During the treatment, there were 4 mild adverse reactions in the control group and no adverse reactions in the treatment group. CONCLUSION: Chiropractic manipulation can effectively relieve pain and improve lumbar function in patients with degenerative scoliosis. The onset of action is faster than that oral eperisone hydrochloride tablets combined with TSLO brace, and it has better safety and can improve Cobb angle of patients with degenerative scoliosis.

Fetal development of deep back muscles in the human thoracic region with a focus on transversospinalis muscles and the medial branch of the spinal nerve posterior ramus.

Fetal development of human deep back muscles has not yet been fully described, possibly because of the difficulty in identifying muscle bundle directions in horizontal sections. Here, we prepared near-frontal sections along the thoracic back skin (eight fetuses) as well as horizontal sections (six fetuses) from 14 mid-term fetuses at 9-15 weeks of gestation. In the deep side of the trapezius and rhomboideus muscles, the CD34-positive thoracolumbar fascia was evident even at 9 weeks. Desmin-reactivity was strong and homogeneous in the superficial muscle fibers in contrast to the spotty expression in the deep fibers. Thus, in back muscles, formation of the myotendinous junction may start from the superficial muscles and advance to the deep muscles. The fact that developing intramuscular tendons were desmin-negative suggested little possibility of a secondary change from the muscle fibers to tendons. We found no prospective spinalis muscle or its tendinous connections with other muscles. Instead, abundant CD68-positive macrophages along the spinous process at 15 weeks suggested a change in muscle attachment, an event that may result in a later formation of the spinalis muscle. S100-positive intramuscular nerves exhibited downward courses from the multifidus longus muscle in the original segment to the rotatores brevis muscles in the inferiorly adjacent level. The medial cutaneous nerve had already reached the thoracolumbar fascia at 9 weeks, but by 15 weeks the nerve could not penetrate the trapezius muscle. Finally, we propose a folded myotomal model of the primitive transversospinalis muscle that seems to explain a fact that the roofing tile-like configuration of nerve twigs in the semispinalis muscle is reversed in the multifidus and rotatores muscles.

[Kinematic parameters and related influencing factors of sitting lumbar spine manipulation with motion capture].

OBJECTIVE: To explore the influence of individual characteristics of patients on the kinematics parameters of sitting lumbar spine manipulation. METHODS: From January 2016 to December 2016, 30 patients with degenerative lumbar spondylolisthesis were treatede, including 18 males and 12 females, aged from 45 to 61(52.33±2.34) years old, with a course of 2 to 72(29.13±3.23) months. Motion capture technique was used to measure the kinematics parameters of the same manipulator in sitting lumbar spine manipulation for 30 patients, including rotation time, maximum speed and maximum acceleration. The parameters of the left and right hands of the operator were different. The effects of individual characteristics on the kinematics parameters of sitting lumbar spine manipulation were analyzed. RESULTS: The kinematic and mechanical parameters of manipulation were as follows:spin time, maximum speed, maximum acceleration, the manipulation done by right or left hand showed the similar parameters(P>0.05). According to multivariate linear regression, there was a significant correlation between the age of the patient and the rotation time of the operator(P<0.01); the height of patient had a significant correlation with the maximum speed and maximum acceleration of the operator(P<0.01). CONCLUSIONS: There is no difference between the manipulation of left and right hand in clinical application. Age and height are important influencing factors of sitting lumbar rotation manipulation.

Genetic variation in mitochondrial cox2 of Heterakis gallinarum from poultry in Sichuan, China.

Heterakis gallinarum is one of the common parasitic nematodes found in the caecum of poultry. To investigate the genetic diversity and genetic structure of the H. gallinarum population in Sichuan, we amplified and sequenced the complete mitochondrial (mt) cytochrome c oxidase subunit II (cox2) gene of 59 H. gallinarum isolates from seven different geographical regions, then analyzed their genetic polymorphisms. All cox2 genes of the 59 H. gallinarum isolates were 696 bp in length, with an average A + T content of 67.1%. Fifty-nine sequences contained 34 variable sites, and were classified into 23 haplotypes (HS1-HS23). The values of haplotype diversity (Hd) and nucleotide diversity (π) were 0.688 and 0.00288, respectively. Based on values of FST and Nm (FST = 0.01929, Nm = 12.71), there was a frequent gene flow but no significant genetic differentiation observed among the populations. The network map showed that the most prominent haplotype was HS1, and the other haplotypes (HS2-HS23) were centered on HS1 with a star-like topology, indicating that H. gallinarum had previously experienced a population expansion. To our knowledge, this is the first research on the population genetics of H. gallinarum based on mitochondrial cox2.

Absence of population genetic structure in Heterakis gallinarum of chicken from Sichuan, inferred from mitochondrial cytochrome c oxidase subunit I gene.

Population genetics information provides a foundation for understanding the transmission and epidemiology of parasite and, therefore, may be used to assist in the control of parasitosis. However, limited available sequence information in Heterakis gallinarum has greatly impeded the study in this area. In this study, we first investigated the genetic variability and genetic structure of H. gallinarum. The 1325 bp fragments of the mitochondrial COX1 gene were amplified in 56 isolates of H. gallinarum from seven different geographical regions in Sichuan province, China. The 56 sequences were classified into 22 haplotypes (H1-H22). The values of haplotype diversity (0.712) and nucleotide diversity (0.00158) in Sichuan population indicate a rapid expansion occurred from a relatively small, short-term effective population in the past. The haplotype network formed a distribution around H1 in a star-like topology, and the haplotypes did not cluster according to their geographical location. Similar conclusions could be made from MP phylogenetic tree. The Fst value (Fst<0.16965) and AMOVA analysis revealed that no significant genetic differentiation was observed among the seven different geographical populations. Neutrality tests (Tajima's D and Fu's Fs) and mismatch analysis indicated that H. gallinarum experienced a population expansion in the past. Our results indicated that H. gallinarum experienced a rapid population expansion in the past, and there was a low genetic diversity and an absence of population structure across the population.

Mitochondrial genomes of Heterakis gallinae and Heterakis beramporia support that they belong to the infraorder Ascaridomorpha.

Heterakis gallinae and Heterakis beramporia are the most prevalent nematode infecting native chicken breed, causing major economic losses. In the present study, the complete mitochondrial genomes (mt) of H. gallinae and H. beramporia were amplified by long-PCR and then sequenced. The complete mt genomes of H. gallinae and H. beramporia were 13,973bp and 14,012bp in size, respectively. Both mt genomes contain 12 protein-coding genes, 22 transfer RNA genes and 2 ribosomal RNA genes. All genes are transcribed in the same direction and the gene arrangement is identical to Ascaridia spp. Phylogenetic analysis based on the 12 protein-coding genes revealed that the family Heterakidae (represented by H. gallinae and H. beramporia) was more closely related to the infraorder Ascaridomorpha than it was to the infraorder Oxyuridomorpha. The present study determined the complete mt genome sequences for two Heterakis species, providing useful markers for studying the systematics, population genetics, and molecular epidemiology of these Heterakis parasites.

Long-term lamivudine for chronic hepatitis B and cirrhosis: A real-life cohort study.

AIM: To investigate clinical outcomes of chronic hepatitis B (CHB) and liver cirrhosis (LC) patients under whole-course management with lamivudine (LAM). METHODS: This was a retrospective-prospective cohort study based on two nonrandom cohorts of Chinese patients (LAM group and history control group). Two hundred thirty-eight patients with LAM treatment for at least 12 mo under whole-course management were included in the LAM group. The management measures included regular follow-up and timely adjustment of the therapeutic regimen according to drug-resistance and relapse. Two hundred thirty-eight patients with CHB or LC without any antiviral treatment and with follow-up over 12 mo were included in the history control group. The LAM and control group patients were 1:1 matched by propensity score method to ensure both patients were similar in general datum, sex, age, E antigen, and diagnosis. The incidence rates of endpoint events [LC, hepatocellular carcinoma (HCC), and death] were compared between the LAM and control groups. RESULTS: Hepatitis B virus-DNA < 1000 copies per mL rate and rate of alanine transaminase < 1.3 of the upper normal limit in LAM and control groups were 89.1% vs 18.5% (P < 0.05) and 89.8% vs 31.1% (P < 0.05), respectively. Viral breakthrough occurred in 77 patients (32.4%); the one-, three-, and five-year cumulative rates were 6.8%, 33.1%, and 41.3%, respectively. In total, 44.5% (106/238) of patients had once stopped LAM, and 63 (59.4%) of them developed virologic relapse; the relapse rate of patients with and without reaching Asian Pacific Association for the Study of the Liver endpoint criteria were 52.4% and 69.8%, respectively. Six CHB patients in the LAM group developed LC compared to 47 patients in the control group; the three-, and five-year cumulative rates of CHB at baseline of LAM were lower than those of the control group: 0.7% vs 12.0% and 1.8% vs 23.8% (P < 0.01), respectively. The incidence of HCC in CHB at baseline of LAM was lower than that of the control group; the three-, and five-year cumulative rates were 0% vs 3.2% and 1.1% vs 3.2% (P = 0.05), respectively. The incidence of HCC in LC at baseline of LAM was lower than that of the control group: 9.8% (5/51) vs 25.0% (12/48), and the three-, and five-year cumulative rates were 4.5% vs 20.7% and 8.1% vs 37.5% (P < 0.01), respectively. The mortality rate in the LAM group was lower than the control group. CONCLUSION: Standardized long-term LAM treatment in combination with comprehensive management can reduce the incidence rates of LC and HCC as well as hepatitis B virus-related deaths.

[Study on the effect of cold air over the coagulation function by exposing healthy rats and hypertensive rats to a simulated cold air].

OBJECTIVE: To explore the effect of temperature dropping process in cold air on the coagulation function both in healthy and hypertensive rats. METHODS: Twenty-four male healthy Wistar rats and 24 male spontaneous hypertensive rats (SHR) were randomly divided into the minimum temperature group (Tim), Tmin control group (Tmin-c), recovery temperature group (Tr) and Tr control group (Tr-c), With the simulated temperature dropping process of a cold air, collected from Zhangye city in March of 2011, the groups of Tmin and Tr were exposed to this process. Both at the Tmin and Tr, blood were collected from the rats for coagulation function measurements. RESULTS: Compared with the control group, no significant difference was found in the results of activated partial thrombin time(APIT), pro-thrombin time (PF) and thrombin time (TT) between any groups in any strains (P > 0.05). The fibrinogen (Fbg) and fibrinogen-time were found to be obvious higher and shorter in Tmin and Tr of healthy rats and in Tmin of hypertensive rats in contrast to the control group. Hypertensive rats had higher level of fibrinogen and shorter level of fibrinogen-time. CONCLUSION: The temperature dropping process induced the increase of plasma Fbg both in the healthy and hypertensive subjects, which might be the reason to explain the higher occurrence of cardiovascular diseases event especially these activated through the formation of thrombin during cold air stress. Besides, the coagulation function of healthy subjects was more likely to be affected by cold air than the hypertensive subjects.