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Objective:To analyze the prevalence and distribution characteristics of diffuse idiopathic skeletal hyperostosis (DISH) in hospitalized patients with thoracic ossification of the ligamentum flavum (TOLF).Methods:The clinical records of 132 consecutive TOLF patients from January 2018 to June 2019 were retrospectively studied. DISH was identified by the preoperative X-ray and CT and its prevalence was calculated. The prevalence of patients with different genders, different age groups and different ossification types was compared. The segmental distribution of DISH and the distribution in the upper (T 1-T 4), middle (T 5-T 8), and lower thoracic spine (T 9-T 12) were analyzed. Ossification degree of DISH was evaluated based on the Meta scoring system. The demographic characteristics (age, gender, BMI, etc.) were compared between DISH and non-DISH group. Results:Forty-nine patients was diagnosed as DISH with the prevalence of 37.1% in all included cases. The prevalence was about twice as high in male (46.3%) than in female (23.1%) ( χ2=8.806, P=0.003). The prevalence in the age groups of <40, 40-49, 50-59, 60-69 and ≥70 years was 20.0%, 28.0%, 34.4%, 44.0%, and 66.7%, respectively. The prevalence in long-segment TOLF patients (45.1%) was significantly higher than that in short-segment TOLF patients (24.0%) ( χ2=5.937, P=0.015). DISH most frequently affected T 8,9 levels (91.8%). The total number and mean number of ossified segments were 365 and 7.4, respectively. Ossification lesions in the upper, middle, lower thoracic spine accounted for 26.03%, 40.54%, and 33.15%, respectively. Grade I, grade II, and grade III ossification accounted for 21.4%, 28.5% and 50.1%, respectively. The mean age of the DISH group was older than the non-DISH group ( t=2.024, P=0.045). The proportion of male patients in the DISH group was significantly higher than that in the non-DISH group ( χ2=8.806, P=0.003). The average height and weight in the DISH group were significantly greater than those in the non-DISH group ( t=2.564, P=0.012; t=2.191, P=0.030), whereas no significant differences in BMI and constituent ratio of concurrent diabetes, cardiac disease, hypertension between two groups were observed. Conclusion:The prevalence of DISH in patients with TOLF is 37.1%. Male, elderly and long-segment TOLF patients are associated with higher prevalence. DISH frequently occurs in the middle and lower thoracic spine, and T 8,9 is the common affected segment. Ossification lesions may develop with age. Demographic characteristics of DISH group differ, to some extent, from those of non-DISH group.
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Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are safe and effective minimally invasive spinal techniques for the treatment of osteoporotic and pathological vertebral fractures, which are widely used in clinical practice. Cement leakage is the most common complication, which can lead to serious consequences such as adjacent vertebral refracture, pulmonary or cerebral embolism and paraplegia. Clinically, bone cement can penetrate into different sites along different paths, form different morphologies, and present different clinical symptoms. Therefore, an impeccable classification of bone cement leakage is beneficial to study its incidence, risk factors and prevention and treatment measures. So far, domestic and foreign scholars have proposed a variety of bone cement leakage classifications and elucidated its clinical significance despite certain limitations, but no uniform standard is established. Therefore, this review summarizes various classification and risk factors of cement leakage and evaluates their clinical implications, aiming at providing a reference for further clinical studies.
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Hair loss is a common problem encountered by both male and female in social life. A variety of systemic diseases, skin diseases, trauma, etc. can lead to hair loss, but androgenetic alopecia is its main cause. Hair loss can cause a series of influences, such as affecting one's self-esteem and emotional health. Healthy and beautiful hair is very important for a person's external image, and the external image can affect a person's work and life to some extent. Hair transplantation surgery has gradually evolved, and its surgical effect is remarkable. However, hair transplantation technology is still not perfect and still faces many challenges, including the supply of hair, the survival rate of the hair, the length of the operation and the concealment of marks after the operation. In this paper, the current status of hair transplant surgery and some important challenges and possible solutions were discussed.
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Ossification of posterior longitudinal ligament (OPLL) and ossification of ligamentum flavum (OLF) are clinically common heterotopic ossification diseases, which are the main causes of cervical and thoracic spinal stenosis and spinal cord injury. In some cases, OPLL and OLF may involve multiple spinal sites, individually or concurrently, increasing the difficulty of clinical diagnosis and treatment. This review initially attempts to define this specific ossification phenomenon as Tandem ossification of intraspinal ligaments (TOIL). It refers to a kind of severe spinal ligament ossification diseases caused by multiple factors, that OPLL and OLF occur alone or in combination at two or more sites of the cervical, thoracic, or lumbar spine with five or more ossified segments, progressively compressing the spinal cord or nerves, thereby resulting in a series of complex clinical symptoms. The prevalence of TOIL remains unknown, but its clinical detection rate is relatively high, and the most common TOIL is cervical OPLL combined with thoracic OPLL or/and OLF. Moreover, occurrence and development of TOIL involve many factors and its definitepathogenesis is not clear. Damage of upper and lower motor neurons can occur simultaneously in TOIL patients so that their clinical symptoms and signs often interfere with each other. TOIL has various forms, complex imaging features, and no uniform diagnostic and localization diagnostic criteria, which may easily lead to missed diagnosis and misdiagnosis. It is recommended that TOIL is identified by the typical symptoms and signs as the basis, CT three-dimensional reconstruction and MRI signs as the reference, and combination of the possible risk factors and clinical experience. Currently, surgical decompression for responsible lesions is the only effective treatment for symptomatic TOIL. However, domestic and foreign scholars still have great arguments on the optimal surgical strategy of TOIL. No consensus has been reached on how to determine the operating segment and the extent of decompression, which surgical approach and technique to be adopted, and when to select staged or one-stage combined surgery. Therefore, this review summarizes and discusses the current status and progress of the clinical characteristics and surgical strategies of TOIL through searching the relevant literature, to provide a reference for clinicians to diagnose and treat TOIL.
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Thoracic ossification of ligament flavum (TOLF) is a pathological process of heterotopic bone formation from ligamentum flavum tissue, which is the most common cause of thoracic spinal stenosis and thoracic myelopathy. Imaging examination is the predominant measure for localization and qualitative diagnosis for TOLF. Various TOLF classification systems have been reported currently, based on its morphology, distribution, configuration of compressed spinal cord or its association with peripheral tissue structures. However, there has been no unified classification due to confusing clinical applications. Therefore, we conducted a review to summarize TOLF classification systems and to evaluate the reliability of these classification systems and the diagnostic accuracy of various imaging modalities. As demonstrated in literatures, the diagnostic accuracy of radiography and the reliability of related classification were low. CT-based Sato classification (lateral, extended, enlarged, fused, tuberous) and Kuh classification (unilateral, bilateral, bridging), MRI-based Kuh classification (round, beak) and Chen Zhongqiang classification (isolated, skipping, continuous), Muthukumar classification combined with dural ossification (Tram track sign, Comma sign) elaborated ossification characteristics from different angles and dimensions. These classification systems were clinically significant in pathogenesis implication, risk assessment, treatment guidance and prognosis judgement, which showed high diagnostic accuracy and reliability. Combining multi-dimension and multi-level parameters of CT and MRI will play an important role in the diagnosis, treatment and new classification research of TOLF.
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Thoracic ossification of ligament flavum (TOLF) is a chronic progressive disease presenting the heterotopic ossification of the ligamentum flavum of the thoracic spine, which leads to a series of symptoms and signs of thoracic spinal cord, nerveor vascular compression, with a high incidence in East Asian countries such as China and Japan. The pathology of TOLF is endochondral ossification in nature and surgical intervention is currently the only effective treatment due to conservative treatment does not work. The older age, the insidious onset, the various clinical manifestations of TOLF patients make the localization diagnosis and surgery management difficult and even bring about the high incidence of postoperative complications. Therefore, it is particularly important to study the mechanism of osteogenic differentiation of TOLF to find a way of early diagnosis and prevention. A variety of factors related to osteogenic differentiation of TOLF have been found, such as genetics, mechanical stimuli, molecular biological factors, metabolic and trace element abnormalities and so on. Moreover, molecular signaling pathways play a crucial role in regulating cell proliferation and directed differentiation. Therefore, this article reviews the confirmed relevant signaling pathways in the process of ligamentum flavum ossification, including bone morphogenetic protein (BMP) signaling pathway, mitogen-activated protein kinase (MAPK) signaling pathway, Wnt signaling pathway, Notch signaling pathway, STAT3 signaling pathway and other signaling pathways and factors, and also summarizes the promotion and inhibition of these signaling pathways in the osteogenic differentiation of ligamentum flavum cells, aiming at establishing a basis for the further research of the molecular biological mechanism of TOLF, and providing a possible direction for exploration of effective preventive and therapeutic targets.
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Objective@#To analyzed demographic and clinical characteristics in hospitalized patients with osteoporotic vertebral compression fractures(OVCFs)and to provide certain evidence for prevention and treatment of the disease.@*Methods@#Retrospectively analyzedthe clinical data of 2 028 patients with OVCF from January 2009 to December 2018 in the Spine Department of Qilu Hospital of Shandong University. The trend of composition ratio and average age of OVCF patients in the past ten years were observed, the differences of the demographic characteristics and clinical characteristics between different genders as well as the correlation between the number of fractured vertebral bodies of OVCF and various influencing factors were analyzed, and the characteristics of OVCF inpatients were summarized.@*Results@#Of 2 028 patients, 374 were males and 1654 were females.The average age was 70.50±9.73 years old, and the male is 73.29±10.23 and the female is 69.87±9.46. A significant increase in the constituent ratio of OVCF between 2009 and 2018 (6.85% in 2009 vs. 13.24% in 2013) and the mean age of OVCF patients increased from 67.54±9.92 years in 2009 to 70.96±9.63 years in 2018were identified.There were significant differences in age distribution of OVCFs in different gender. When the age was less than 70 years old,the fracture ratio of female was higher than that of males, especially between 60 and 70 years old (38.63%∶17.91%); However, when the age was more than 70 years, the fracture ratio of male was higher than that of female especially after 80 years old(29.15%:12.70%). There were significant differences in occupation distribution of OVCFs indifferent gender. Peasants (47.94%), professionals (18.32%) and workers (14.63%) were the top three in female while peasants (35.56%), workers (26.47%) and professionals(20.05%) in male. Falling was the main injury cause of OVCF and there were significant differences in the distribution of causes of OVCF injuries between different genders. The proportion of traffic accident injuries infemaleswas higher than that in maleswhile the proportion of sprains inmaleswas higher than that in females.Moreover,there was a statistically significant difference in the distribution of fracture vertebral bodies between patients of different ages, with or without fracture history and smoking history and different ages of menopause.Among them, the number of fractured vertebral bodies was positively correlated with age(r=0.79, P<0.05).The composition ratio of single vertebral fracture of patients without fracture history, menopausal ageunder 50 and withoutsmoking history was higher than that with fracture history, menopausal age over 50 and with smoking history. On the contrary,the composition ratio of two or more vertebral fractures in patients without fracture history and menopausal agebelow 50 was lower than thatwith fracture history and menopausal ageover 50. Particularly, the ratio of three or more vertebral fractures with smoking history was higher than thatwithout smoking history.The number of patients who adopted bone mineral density(BMD) test and bone turnover maker test was 118 and 106 before 2014 while the number was 568 and 837 after 2014 and the differences were statistically significant.@*Conclusion@#The proportion of OVCFs in spine diseases and average age of patients in the period of 2009-2018 was increasing gradually. Distribution of the age,occupation and cause of injury were related to the gender, but there was no correlation between distribution of season, fracture segment and comorbidities and gender. The age, previous fracture history, female menopausal age and smoking history were correlated with the number of fractured vertebral bodies while drinking history was not related.
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Objective To analyzed demographic and clinical characteristics in hospitalized patients with osteoporotic vertebral compression fractures(OVCFs)and to provide certain evidence for prevention and treatment of the disease.Methods Retrospectively analyzedthe clinical data of 2 028 patients with OVCF from January 2009 to December 2018 in the Spine Department of Qilu Hospital of Shandong University.The trend of composition ratio and average age of OVCF patients in the past ten years were observed,the differences of the demographic characteristics and clinical characteristics between different genders as well as the correlation between the number of fractured vertebral bodies of OVCF and various influencing factors were analyzed,and the characteristics of OVCF inpatients were summarized.Results Of 2 028 patients,374 were males and 1654 were females.The average age was 70.50±9.73 years old,and the male is 73.29± 10.23 and the female is 69.87±9.46.A significant increase in the constituent ratio of OVCF between 2009 and 2018 (6.85％ in 2009 vs.13.24％ in 2013) and the mean age of OVCF patients increased from 67.54±9.92 years in 2009 to 70.96±9.63 years in 2018were identified.There were significant differences in age distribution of OVCFs in different gender.When the age was less than 70 years old,the fracture ratio of female was higher than that of males,especially between 60 and 70 years old (38.63％:17.91％);However,when the age was more than 70 years,the fracture ratio of male was higher than that of female especially after 80 years old(29.15％:12.70％).There were significant differences in occupation distribution of OVCFs indifferent gender.Peasants (47.94％),professionals (18.32％) and workers (14.63％) were the top three in female while peasants (35.56％),workers (26.47％) and professionals(20.05％) in male.Falling was the main injury cause of OVCF and there were significant differences in the distribution of causes of OVCF injuries between different genders.The proportion of traffic accident injuries infemaleswas higher than that in maleswhile the proportion of sprains inmaleswas higher than that in females.Moreover,there was a statistically significant difference in the distribution of fracture vertebral bodies between patients of different ages,with or without fracture history and smoking history and different ages of menopause.Among them,the number of fractured vertebral bodies was positively correlated with age(r=0.79,P＜0.05).The composition ratio of single vertebral fracture of patients without fracture history,menopausal ageunder 50 and withoutsmoking history was higher than that with fracture history,menopausal age over 50 and with smoking history.On the contrary,the composition ratio of two or more vertebral fractures in patients without fracture history and menopausal agebelow 50 was lower than thatwith fracture history and menopausal ageover 50.Particularly,the ratio of three or more vertebral fractures with smoking history was higher than thatwithout smoking history.The number of patients who adopted bone mineral density(BMD) test and bone turnover maker test was 118 and 106 before 2014 while the number was 568 and 837 after 2014 and the differences were statistically significant.Conclusion The proportion of OVCFs in spine diseases and average age of patients in the period of 2009-2018 was increasing gradually.Distribution of the age,occupation and cause of injury were related to the gender,but there was no correlation between distribution of season,fracture segment and comorbidities and gender.The age,previous fracture history,female menopausal age and smoking history were correlated with the number of fractured vertebral bodies while drinking history was not related.
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OBJECTIVE@#To analyse the effect of low intensity pulsed ultrasound stimulation (LIPUS) on accelerating the fibrocartilage layer repair of patella-patellar tendon junction.@*METHODS@#A total of 60 mature female New Zealand white rabbits undergoing standard partial patellectomy were divided into 2 groups randomly. The control group was given comfort treatment and the treatment group was given LIPUS treatment starting from day 3 to the end of week 6 postoperatively. The scheduled time points of animal euthanization would be at week 6, week 12 and week 18 postoperatively. The patella-patellar tendon (PPT) complex would be harvested and cut into sections after decalcification for H&E staining, Safranine o/fast green staining. The thickness and gray value of fibrocartilage layer were analyzed by SANO Microscope Partner image analyzer.@*RESULTS@#At week 6, week 12 and week 18 postoperatively, the fibrocartilage layer in the treatment group was significantly thicker than that in the control group (P<0.01), and the gray value of fibrocartilage layer was significantly smaller than that in the control group (P<0.01).@*CONCLUSION@#LIPUS helps to accelerate the fibrocartilage layer repair of patella-patellar tendon junction in rabbit models.
Subject(s)
Animals , Female , Rabbits , Fibrocartilage , Pathology , Patella , General Surgery , Patellar Ligament , Wounds and Injuries , Pathology , General Surgery , Tendon Injuries , Therapeutics , Ultrasonic Therapy , Methods , Wound Healing , PhysiologyABSTRACT
Objective To investigate the expression of MMP-2 and MMP-7 and their elinieopathologieal significance in eoloreetal carcinomas. Methods The expression of MMP-2 mRNA, MMP-7 mRNA and MMP-2, MMP-7 in 42 samples of eoloreetal carcinomas and its adjacent normal eoloreetal mueosa were examined using fluo-rescence quantitative RT-PCR (FQ-RT-PCR) and immunohistoehemistry. The relationship of their expression with some elinieopathologieal characteristics was analyzed. Results MMP-2 mRNA, MMP-7 mRNA and MMP-2, MMP-7 were significantly over-expressed in eoloreetal carcinomas compared with its adjacent normal eoloreetal mueosa( P < 0.05 ) , and they were positively associated with bowel wall invasion, the regional lymph node metastasis and Dukes stage. The expression of MMP-2 mRNA and MMP-7 mRNA was positively correlated with MMP-2 and MMP-7 in eoloreetal eareinornas. Conclusions MMP-2 and MMP-7 may play a key role in eoloreetal carcinogenesis,tumor in-vasion and metastasis. Examination of combined MMP-2 and MMP-7 expression may have an important significance to judge the malignant degree and biological behavior of human eoloreetal carcinoma and for evaluating the progno-sis.
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Objective To investigate the expression and clinicopathological significance of matrix metallo-proteinase(MMP-9) and matrix metalloproteinase tissue inhibiting factor-1 (TIMP-1) in colorectal carcinomas.Methods Immunohistochemistry (PowerVision method) in the paraffin embedded tissue samples was used to deter-mine MMP-9 and TIMP-1 in 42 colorectal carcinomas and its adjacent normal colorectal mucosa.The relationship of their expression with some clinicopathological characteristics was analyzed.Results MMP-9 and TIMP-1 were both significantly overexpressed in colorectal carcinomas compared with its adjacent normal colorectal mucosa(69.1% and 61.9% vs.45.2% and 40.5% ,P =0.009 and P =0.004) ,and MMP-9 was positively associated with the re-gional lymph node metastasis,bowel wall invasion and Dukes stage(rs=0.372,P =0.015;rs =0.372,P =0.015;rs = 0.429,P = 0.005).TIMP-1 was positively associated with Dukes stage, bowel wall invasion and regional lymph node metastasis (rs = 0.394, P = 0.010;rs= 0.382,P = 0.013rs = 0.382, P = 0.013 ).There was a positive corre-lafion between the expression of MMP-9 and TIMP-1 (rs=0.641, P <0.001).Conclusion MMP-9 and TIMP-1 may play a key role in colorectal carcinogenesis.Examination of MMP-9 and TIMP-1 expression may have an impor-tant significance for evaluating prognosis, predicting of invasion and metastasis and comprehensive therapy.