الملخص
Objective To evaluate the minimally invasive treatment of calcaneal fractures of Sanders Ⅱ &Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires.Methods From June 2016 to February 2018,53 patients (60 feet) were treated at Department of Hand and Foot Surgery,Central Hospital of Linyi for closed intra-articular calcaneal fractures.Of them,24 (28 feet) received the minimally invasive treatment and 29 (32 feet) open surgery via the conventional lateral L-shaped incision.The 2 groups were compared in terms of B(o)hler angle,Gissane angle,and the width,length and height of the calcaneus before operation,one week after operation and at the final follow-up,as well as in terms of preoperative preparation time,operation time,surgical bleeding volume,incision complications,subtalar joint stiffness,and anklehindfoot score of the American Foot and Ankle Surgery Association (AOFAS).Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data (P ＞ 0.05).All the patients were followed up for 10 to 22 months (average,16 months).The B(o)hler angles,Gissane angles,and the widths,lengths and heights of the calcaneus after operation and at the final follow-up were significantly better than the preoperative values in the minimally invasive group (all P ＜ 0.05).The preoperative preparation time (2.5 d ± 1.2 d) and operation time (62.6 min ± 6.3 min) in the minimally invasive group were significantly shorter than those (7.6 d ± 3.5 d and 85.9 min ± 9.7 min) in the conventional group (P ＜ 0.05),the surgical bleeding volume in the former (30.5 mL ± 3.8 mL) was significantly smaller than that in the latter (80.9 mL ± 8.3 mL) (P ＜ 0.05),and the rates of incision complications (0) and subtalar joint stiffness (10.7％) in the former were significantly lower than in the latter (9.4％ and 43.7％) (P ＜ 0.05).However,there was no significant difference between the 2 groups in the AOFAS anlle-hindfoot score (92.8 ± 5.9 versus 89.5 ± 7.5) (P ＞ 0.05).Conclusion The minimally invasive treatment of calcaneal fractures of Sanders Ⅱ & Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires can lead to satisfactory clinical results,because this method shortens significantly the time for hospitalization and leads to less invasion,fewer complications,accurate reposition and reliable fixation.
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Objective To explore the relationship between Toll-like receptor 2(TLR2) and autophagy marker protein in glioma. Methods Glioma tumors of a total of 74 patients from June 2012 to December 2017 were surgically resected, including WHO gradeⅠtoⅡ32 cases, grade Ⅲ 20 cases, gradeⅣ22 cases. Immunohistochemistry and Western blot were used to detect the expression of TLR2, autophagy related protein LC3B, Beclin 1 and apoptosis related protein Bax and Bcl-2. The correlation between TLR2 and autophagy related protein LC3B and Beclin 1 were analyzed. Results In high grade glioma (HGG) tissue and low grade glioma (LGG) tissue, the TLR2 positive expression rates were 92.9％(39/42) and 75.0％(24/32), and there was significant difference (P<0.05). In HGG tissue, autophagy related protein LC3B, Beclin1 protein was strongly positive and the positive expression rates were 45.2％(19/42) and 52.4％(22/42). In LGG tissue, LC3B and Beclin1 protein positive expression rates were 18.8％(6/32) and 15.6％(5/32), and there were significant differences (P<0.05). Spearman correlation analysis showed that TLR2 protein was closely related to autophagy related protein LC3B (r=0.5638, P<0.05) and Beclin1 (r=0.6101, P<0.05). Conclusions TLR2 is highly expressed in HGG tissue, and its expression level may be related to autophagy, which has potential value as a targeted therapy.
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Objective To compare the clinical efficacies of endoscopy-assisted microvascular decompression and microscopic microvascular decompression.Methods PubMed,Cochrane Library,Embase,VIP,CNKI and Wanfang database were retrieved.The randomized controlled trials comparing trigeminal neuralgia and hemifacial spasm treated with endoscopy-assisted microvascular decompression and microscopic microvascular decompression were chosen.The retrieval time was from the establishment of the database to April 1st,2017.After the detected literatures being screened,extracted and evaluated,a Meta-analysis was performed using RevMan 5.3 software.Results Finally,a total of 10 trials with 1010 patients were enrolled.The results of Meta-analysis showed:(1) in the aspect of effectiveness,patients from the neuroendoscope group had significantly better prognosis (RR=1.110,95％CI:1.060-1.160,P=0.000) and statistically lower relapse rate (RR=0.100,95％CI:0.020-0.530,P=0.007) as compared with the microsurgery group;(2) in the aspect of safety,patients from the neuroendoscope group had fewer postoperative complications (RR=0.650,95％CI:0.530-0.800,P=0.000) and lower postoperative paralysis incidence rate (RR=0.580,95％CI:0.360-0.930,P=0.020) as compared with the microscope group.There were no significant differences in the operation time,incidence of cerebrospinal fluid leakage,hearing loss or intracranial infections between the 2 groups (P＞0.05).Conclusion As compared with those in patients accepted microscopic microvascular decompression,the prognosis of patients accepted endoscopy-assisted microvascular decompression is better,the relapse rate is lower,and safety is higher.
الملخص
Objective To study the design and application of customized navigation module manufactured by digital modeling and 3D-printing technology in the minimal-invasive-puncture surgery for cerebral hemorrhage. Methods Eight patients with cerebral hemorrhage, admitted to our hospital from October 2015 to December 2015 and aged from 33-80 years old (with an average age of 55.7), including 6 male and 2 female, were chosen as study objects. The 3-dimensional image was obtained by three dimensional reconstruction technique. A perfectly personal navigation module included puncturing-guidance-channel was designed and printed by 3D-printing technology. The printing module was tested in surgery. The module was tightly attached to the puncturing area, and the puncturing was performed following the guide system during the surgery. Post-operation cerebral CT scan was performed to evaluate the surgery effect. Results All the 8 patients successfully received surgery. Post-operation cerebral CT scan showed satisfied results which were classified based on accuracy: 6 enjoyed highly accurate results, one qualified result and one acceptable result. The actual puncture direction was the same with that in the pre-operation mimic process. No puncture failure, blood vessel or nervous injury symptoms were found. Conclusion Pre-operation personal 3D printing navigation is an accurate, safe and effective novel method to treat cerebral hematoma.
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Objective To observe the protective effect of grape seed proanthocyanidin extract ( GSPE) on learning disabilities after radiation injury brain in rats.Methods 120 male Wistar rats were divided into control group,model group,high and low dose GSPE groups.The radiation injury brain models were established using a method of linear accelerator irradiation in 22 Gy.The morphological changes of neu-rons in hippocampus were observed with HE staining; the expression of phosphorylated extracellular signal regulated kinase 1/2 ( ERK1/2) and growth associated protein-43( GAP-43) were detected by immunohisto-chemistry;the contents of malonalde hyde(MDA) and superoxide dismutase(SOD) were measured respec-tively by thiobarbituric acid( TBA) and xanthine oxidation( XTO) methods;the learning ability was assessed with shuttle box.Results Compared with the model group,the GSPE groups showed a decreased degree of nerve cell morphological injury; and increased ERK1/2 activities((13.20±1.45)/view,(27.40±2.52)/view,(19.80±1.30)/view),GAP-43 expression level((52.93±2.07)/view,(66.50±0.77)/view,(73.05± 2.40)/view) and SOD activities((79.82±5.26) U/mg,(76.20±6.86) U/mg,(80.12±5.76) U/mg)(P<0.05);and decreased the contents of MDA((71.62±1.88) μmol/g,(76.41±1.94) μmol/g,(72.32±1.98)μmol/g)(P<0.05).Shuttle box testing showed that the active avoidance reaction rate was increased(7 d:(56.23±2.56)%;14 d:(44.66±2.79)%;28 d:(50.40±2.16)%)(P<0.05)and passive avoidance latency was shorted(7 d:(34.11±1.57)s;14 d:(45.52±1.88)s;28 d:( 39.52±1.79)s)(P<0.05) in GSPE groups. The above mentioned changes were more significant in high dose of GSPE(P<0.05) .Conclusion GSPE has protective effect on learning disabilities of radiation injuries brain,which is related to enhance ERK1/2 activ-ity and the expression of GAP-43.
الملخص
@#Objective To observe the effect of grape seed proanthocyanidin extract (GSPE) on growth associated protein-43 (GAP-43) through extracellular signal regulated kinase 1/2 (ERK1/2) pathway in rats with brain radiation injury. Methods 72 3-month male Sprague-Dawley rats were divided into control group (n=18), model group (n=18), high dose GSPE group (n=18) and low dose GSPE group (n=18). The brain radiation injury models were established by linear accelerator irradiation with 22 Gy. The learning ability was assessed with shuttle box. The morphological changes of neurons in hippocampus were observed with HE staining;the expression of GAP-43 was de-tected by RT-PCR; and the expression of phosphorylated ERK1/2 was detected by Western blotting. Results Compared with the model group, the active avoidance reaction rate in the shuttle box test increased and the passive avoidance latency shortened in GSPE groups (P<0.001); the nerve cell morphological injury reduced and the expression of GAP-43 mRNA and phosphorylated ERK1/2 increased in the GSPE groups (P<0.001), especially in the high dose GSPE group (P<0.001). The GAP-43 mRNA level positively correlated with phosphory-lated ERK1/2 level in the model group (r=0.764, P<0.001), the low dose GSPE group (r=0.814, P<0.001) and the high dose GSPE group (r=0.822, P<0.001). Conclusion GSPE could promote the expression of GAP-43 through ERK1/2 pathway in rats, and prevent the brain from radiation injury.
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Objective To investigate the effect of butylphthalide on brain edema and the expression of phosphorylated myosin light chain in peri-infarct tissue in focal cerebral ischemic rats.Methods A total of 212 adult male Sprague-Dawley rats were divided into a sham operation group (n =12),a cerebral ischemia group (n =100),and a butylphthalide group (n =100) (40 mg/kg,1/day,gavage) according to the random number table.Both the cerebral ischemia group and the butylphthalide group were redivided into 6 h,12 h,1 d,3 d,and 7 d groups (n =20 for each time point).A rat model of focal cerebral ischemic model was induced by photochemical method; 2,3,5-triphenyl tetrazolium chloride (TTC) staining was used to detect infarct volume (n =5); wet-dry weight method was used to detect the water content in brain tissue (n =5);immunohistochemistry (n =5) and Western blot (n =5) were used to detect the protein expression of periinfarct cortical p-MLC.Results TTC staining showed that no infarcts were observed in the sham operation group.The infarct volumes at each time points in the butylphthalide group were significantly less than those at the same time points in the cerebral ischemia group (all P ＜0.05).Wet-dry weight method showed that the water contents in brain tissue in the cerebral ischemia group and the butylphthalide group were significantly higher than that in the sham operation group (all P ＜ 0.05),but the water contents in brain tissue at each time points in the butylphthalide group was significantly lower than those at the same time points in the cerebral ischemia group (all P ＜ 0.05).Both immunohistochemistry and Western blot showed that the expressions of peri-infarct cortical p-MLC in both the cerebral ischemia group and the butylphthalide group were upregulated significantly compared to the sham operation group (all P＜ 0.05),but the expressions of peri-infarct cortical p-MLC at each time points in the butylphthalide group was significantly lower than those at the same time points in the cerebral ischemia group (all P＜ 0.05).Conclusions Butylphthalide can be up-regulated by reducing the expression of p-MLC caused by cerebral ischemia and reduce cerebral edema,and then reduce the infarct volume,and thus play a neuroprotective effect.
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Objective To investigate the clinical characteristics and treatments of patients with long-term oral aspirin treatment combined with craniocerebral injury.Methods A retrospective analysis was made on 24 cases admitted for long-term oral aspirin treatment combined with craniocerebral injury from January 2010 to June 2012.There were 15 males and 9 females at age of 52-78 years (mean,63.5years).Injuries were caused by a traffic accident in 18 cases,a high fall in four and a blow in two.GCS on admission was 13-15 points in six cases,10-12 points in 10 cases and ＜ 8 points in eight cases.Six cases had conventional treatment,nine puncture drainage,six intracerebral hematoma evacuation by small craniotomy and three hematoma evacuation by large craniotomy.Results The patients were followed up for three months.Glasgow outcome score (GOS) was used to assess the prognosis in five categories,i.e.,grade Ⅴ (good recovery),grade Ⅳ (low disability),grade Ⅲ (severe disability),grade Ⅱ (vegetative state) and grade Ⅰ (death).Besides,grades Ⅴ and Ⅳ GOS represented a good outcome.Of these patients 15 (62.5％) had good results and nine (37.5 ％) undesirable results.Conclusions Patients with long-term oral aspirin administration combined with craniocerebral injury are characterized by high incidence of delayed and progressive cerebral hemorrhage,multi-focus intracerebral hemorrhage and postoperative rehemorrhagia.Therefore,aspirin therapy should be discontinued.Instead,enough blood coagulation accelerator,platelet and fresh plasma should be given.An operation is necessary for the patients with critically severe conditions but is not advisable for the patients with milder conditions.
الملخص
Objective To investigate the effects of butylphthalide on brain edema,blood-brain barrier permeability and RhoA expression in cortex in focal cerebral infarction in rats.Methods A total of 220 male Sprague Dawley rats were divided into a control,a model and a butylphthalile group (40 mg/kg,once a day,gavage) according to the random number table method.A model of rat focal cerebral infarction was induced by photochemical method.At 3,12,24,72,and 144 h after modeling,wet-dry weight method and Evans blue extravasation method were used to detect the brain water content and blood-brain barrier permeability.At 24 h after modeling,immunohistochemical staining and Western blot were used to detect the expression of RhoA protein in the periinfarction cortex.Results Compared to the control group,the brain water content (except at 6 h) and blood-brain barrier permeability in the model group and the butylphthalide group were increased significantly (all P ＜ 0.05).The immunohistochemical staining and Western blot suggested that the RhoA expression in the periinfarction cortex was upregulated significantly (all P ＜ 0.05).Compared to the model group,the brain water content and blood-brain barrier permeability at different time points in the butylphthalide group were decreased significantly (all P ＜ 0.05).The expression levels of RhoA were also decreased significantly (P ＜ 0.05).Conclusions Butylphthalide may reduce the brain edema of focal cerebral infarction in rats,inhibit disruption of the blood-brain barrier,and down-regulate the expression of RhoA.
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ObjectiveTo explore the relationship of postoperative systemic inflammatory response syndrome(SIRS) and preoperative midway through the urine and perioperative renal pelvis urine of percutaneous nephrostolithotomy(PCNL).Methods Participants included 450 patients with urinary calculus who underwent PCNL,preoperative midway through the urine and perioperative renal pelvis urine of PCNL was collected.ResultsOf 450 cases,preoperative midway through the urine germiculture positive 100 cases (22.2％,100/450 ),perioperative renal pelvis urine germiculture positive 85 cases (18.9％,85/450),46 cases ( 10.2％,46/450) occurred SIRS after PCNL.Decompression of perioperative renal pelvis urine germiculture positive 20 cases(23.5％,20/85) preoperative midway through the urine germiculture positive,perioperative renal pelvis urine the bacteria cultures negative 80 cases (21.9％,80/365 ) preoperative midway through the urine germiculture positive(P ＞0.05),preoperative midway through the urine germiculture positive 15 cases ( 15.0％,15/100) in SIRS,preoperative midway through the urine the bacteria cultures negative 31 cases ( 8.9％,31 /350) in SIRS (P ＞ 0.05 ).Decompression of perioperative renal pelvis urine germiculture positive 18 cases (21.2％,18/85) in SIRS,perioperative renal pelvis urine the bacteria cultures negative 28 cases (7.7％,28/365) in SIRS (P ＜ 0.05 ).ConclusionPreoperative midway through the urine has no correlation with the occurrence of SIRS,perioperative renal pelvis urine germiculture positive can predict the occurrence of SIRS,giving corresponding antibiotic treatment can improve the security of PCNL.
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Objective To explore the value of diagnostic ultrasound mediated microbubble destruction in improving the myocardial perfusion and left ventricular systolic function when cooperated with the mecsenchymal stem cells(MSCs) transplantation in rabbit myocardial ischemia. Methods One week after myocardial ischemia (MI) modeling,36 rabbits were divided into 3 groups,the control group(group Ⅰ) ,intravenous injection of MSCs group(group Ⅱ) and ultrasound + microbubble + MSCs group (group Ⅲ). Myocardial contrast enhancement (MCE) was performed and quantification analysis of anterior wall was assessed with Photoshop. Left ventrieular systolic function was assessed with M-mode echocardiography and bi-plane Simpson's method. CD34 expression in heart was detected with immunohistochemisty(IHC). Western blotting was applied to detect the level of VEGF in three groups. Results The differences of gray scale analyzed with histogram of Photoshop in anterior wall of ischemia myocardium between the group Ⅰ and group Ⅱ or group Ⅲ were significant,and P value was 0. 032 and 0. 000 , respectively. There were significant differences of FS between group Ⅲ (30. 43±4.09)% and group Ⅱ (26.29±2.93)%, P<0.01, and similar to group Ⅰ (19.28 ± 2.84)%. The difference of EF(%) between group Ⅲ and group Ⅱ was significant [(61.5±5.8 vs 53.6±4. 71), P<0. 05] ,or markedly significant between group Ⅲ and group Ⅰ [(61.5±5.8 vs 42.6± 5.0), P <0.01]. EF(%) assessed with bi-plane Simpson's method was significantly increased from (34.64 ± 4.59) in group Ⅰ to (41.78 ± 4.21) in group Ⅱ and (48.6±3.96) in group Ⅲ. The expression of CD34 assessed with immunohistochemistry was the highest in group Ⅲ. The level of VEGF with western blotting in group Ⅲ was significantly higher than other two groups. Conclusions It is an efficacious transplantation means of MSCs infusion under the ultrasound mediated microbubles destruction in improving the myocardial perfusion and cardiac systolic function.
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OBJECTIVE To study the level of plasma fibrinogen in patients with common facial paralysis, and investigate the relationship between the plasma fibrinogen and the pathogenesis of facial paralysis.METHODS A total of 157 inpatients with different kinds of facial paralysis were studied from December 2006 to December 2008.They were etiologically divided into five groups:severe Bell's palsy group(60 cases), moderate Bell's palsy group(19 cases), Ramsay-Hunt syndrome group(28 cases), temporal bone fracture with facial palsy(28 cases), and facial nerve tumor group(22 cases).They were tested for plasma fibrinogen level right after admitted to hospital.RESULTS Plasma fibrinogen level in severe Bell's palsy group was(4.08?0.90)g/L, which was significantly higher than that in other groups and the normal value(2.0～4.0)g/L(P