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Objective:To evaluate the reliability of a region-locked 3D-printed template combined with a bi-directional matching scheme in assistance of screw placement for thoracolumbar fractures.Methods:From January 2019 to March 2023, 52 patients with thoracolumbar fracture were treated at Department of Orthopedics, The People's Hospital of Liyang. They were 29 males and 23 females, with an age of (58.2±13.3) years. They were divided into a template group and a free-hand group according to the different screw placements. In the template group of 25 cases, a region-locked 3D-printed template combined with a bi-directional matching scheme was used to assist the pedicle positioning; in the free-hand group of 27 cases, the free hand screw placement was assisted only by image data and C-arm fluoroscopy. The operation time, intraoperative fluoroscopy frequency, intraoperative blood loss, complications, and placement accuracy were compared between the 2 groups. Visual analogue scale (VAS), Oswestry disability index (ODI), and anterior height ratio of the injured vertebra were compared between preoperation, 1 week postoperation, and the final follow-up, as well as between the 2 groups.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, showing comparability ( P>0.05). All patients were followed up for (11.2±4.2) months. The differences were not statistically significant between the 2 groups in intraoperative blood loss, rate of complications, VAS or ODI at preoperation, 1 week postoperation, or the final follow-up, or in anterior height ratio of the injured vertebra ( P>0.05). In the template group, the operation time [(80.1±18.5) min] was significantly longer than that in the free-hand group [(69.4±16.6) min], the intraoperative fluoroscopy frequency [2 (2, 3) times] significantly lower than that in the free-hand group [3 (3, 4) times], and the placement accuracy [98.4% (127/129)] significantly higher than that in the free-hand group [91.8% (112/122)] (all P<0.05). All patients showed significant improvements in VAS, ODI and anterior height ratio of the injured vertebra at postoperative 1 week compared with the preoperative values, and the improvements at the last follow-up were significantly larger than those at postoperative 1 week ( P<0.05). No injury to the spinal cord, nerve root or blood vessel was observed postoperatively. Conclusions:In the treatment of thoracolumbar fractures, the screw placement assisted by a region-locked 3D-printed template combined with a bi-directional matching scheme is better than free-hand screw placement in terms of improved accuracy and reduced fluoroscopy, but the former incurs longer operative exposure than the latter. There is no significant difference between the 2 methods of screw placement in clinical efficacy.
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BACKGROUND:The osteogenic differentiation of mesenchymal stem cells is regulated by a variety of molecules.Long non-coding RNA(lncRNA)has attracted much attention because they can participate in regulating a variety of biological processes,but the regulatory role of lncRNA on osteogenic differentiation of mesenchymal stem cells has not been fully explored. OBJECTIVE:To explore the effect of lncRNA Gm16104 on osteogenic differentiation of C3H10T1/2 mesenchymal stem cells. METHODS:The C3H10T1/2 mesenchymal stem cells were induced into osteogenic differentiation by bone morphogenetic protein-2.Alkaline phosphatase staining was performed to identify the osteogenic differentiation of the cells 5 days after osteogenic induction.Expression levels of alkaline phosphatase and lncRNA Gm16104 were detected by qRT-PCR after 0,1,3,and 5 days of osteogenic differentiation.After transfection of the overexpression plasmid of pcDNA-Gm16104,the osteogenic differentiation was identified by alkaline phosphatase staining and qRT-PCR 4 days after osteogenic induction.The expression levels of osteogenesis-related signalling pathway proteins were detected by western blot assay. RESULTS AND CONCLUSION:(1)After 5 days of osteogenic induction,alkaline phosphatase activity was significantly increased.(2)Compared with 0 days,expression levels of the osteogenic marker gene alkaline phosphatase increased and expression levels of Gm16104 decreased after 1,3,and 5 days of osteogenic induction.(3)Transfection of C3H10T1/2 cells with pcDNA-Gm16104 plasmid significantly increased the expression level of Gm16104.(4)Overexpression of Gm16104 inhibited alkaline phosphatase activity,the expression levels of the osteogenic marker gene alkaline phosphatase and the osteogenesis-related transcription factor Osterix.(5)Overexpression of Gm16104 inhibited phosphorylated protein expression of PI3K and Akt.(6)The above results suggest that overexpression of Gm16104 may inhibit osteogenic differentiation of C3H10T1/2 mesenchymal stem cells through the PI3K/Akt signaling pathway.
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Objective:To explore the application of 3D printing mirror models and segmentation models in preoperative planning for patellar fractures.Methods:Retrospectively analyzed were the data of 46 patellar fractures which had been treated at Department of Orthopedics, Liyang City People's Hospital from January 2016 to August 2020 using 3D printing mirror models and segmentation models in preoperative planning. There were 26 males and 20 females, aged from 19 to 79 years (average, 51.5 years). All the fractures belonged to AO type C. According to the design requirements of a solid model, the patients with DICOM CT data of bilateral lower extremities were assigned into the mirror model group (24 cases) while those with DICOM CT data of only a unilateral lower extremity into the segmentation model group (22 cases). In the mirror model group, CT scans of bilateral knee joints and the proximal tibia exceeding 15 cm were required, while in the segmentation model group, CT scans of only the affected knee joint were required. The original DICOM data were extracted and imported into software Mimics 19.0. In the mirror model group, after the "three-level long-short axis control" method was used to judge the symmetry, the original fracture model and the mirror model were created and printed respectively. During the operation, the fracture line drawn by the mirror model was used to find the fracture fragments with a similar shape which were to be assembled and fixated. The fracture fragments in the segmentation model group were divided into independent entities, converted into STL files and printed separately before the bone fragments were assembled and fixated in sequence. X-ray films were taken after operation. Recorded were the simulated operation time, visual analog scale (VAS) of the knee joint at one month after operation, and B?stman scores at one and 6 months after operation.Results:All patients were followed up for 6 to 24 months (mean, 13.6 months). In preoperative planning, only the mirror model was suitable for patients with comminuted fracture with compression and impaction, both models were suitable for fractures without impaction, compression or impaction, and the segmentation model was suitable for patients with bilateral fractures at the same site, poliomyelitis, one limb missing, and previous fracture. In the mirror model group in which the patients were controlled bilaterally using the "three-level long-short axis control" method, there was no significant difference among the 6 sets of data at 3 levels on both sides ( P>0.05). For the segmentation model group and the mirror model group, the time for preoperative simulated operation averaged 11.2 min and 9.2 min respectively, the VAS score at one month after operation was both lower than 3 points, and the B?stman scores at one and 6 months after operation were both larger than 20 points. Conclusions:The mirror image model of the unaffected patella can be used as the fracture recovery model for the affected side, but the symmetry needs to be verified in advance in case of severe degeneration. Both the 3D printed mirror model and the 3D segmentation model are suitable for preoperative planning for patellar fractures as they are complementary. Patients in both groups can obtain good joint function after treatment.
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Objective To establish the finite element (FE) model of the anterior tibiofibular ligament injury by ankle fracture fixation, so as to compare the stress and deformation of the finite element model by using anchor-reinforced repair combined with screw fixation. Methods CT images of the ankle joint from a normal young male volunteer was selected to establish the FE model of the anterior tibiofibular joint injury by ankle fracture fixation. The injury models were divided into experimental group and control group, which were fixed by anchors or screws, respectively. The maximum stress distributions and the maximum deformation of the two models under various load conditions were observed through the FE analysis and calculation. Results Under the vertical load, the deformation of the experimental group was 6.8% higher than that of the control group. The deformation increased by 22.6% under external rotation load, while the deformation decreased by 5.1% under internal rotation load. Under the same load, differences in the maximum peak stress on the model between the control group and the experimental group was not significant. Due to the anchor fixation, the maximum stress of the experimental group were borne by the screw that fixed the distal tibial fracture, while the maximum stress of the control group was borne by strong fixation of the steel plate and the inferior tibiofibular screw. The maximum stresses on the anchor were distributed on the screw, and the suture mainly played the role of fixing. Conclusions The lower tibiofibular screw and anchor fixation could effectively treat the tibiofibular instability left by ankle fracture fixation. The anchor fixation dispersed the stress on the steel plate, and it showed greater ankle joint deformation ability while fixing the lower tibiofibula, so as to avoid the risk of broken nails.
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Objective:To evaluate the oncologic outcomes of different laparoscopic radical hysterectomy.Methods:From January 2011 to December 2014, the laparoscopic operation cases of cervical cancer at stage Ⅰb1, Ⅰb2, Ⅱa1 and Ⅱa2, including the histologic subtypes of squamous-cell carcinoma, adenocarcinoma and adenosquamous carcinoma, were collected in five clinical centers. The data were divided into two groups according to the surgical procedures, that is, modified laparoscopic-vaginal radical hysterectomy (mLVRH) and total laparoscopic radical hysterectomy (TLRH). The overall survival rate (OS), disease-free survival rate (DFS) at 5 years were retrospectively analyzed in this study.Results:There were 674 cases in total, including 377 cases of mLVRH, 297 cases of TLRH. (1) The OS at 5 years: the mLVRH was 96.1% and the TLRH was 92.0%, and the mLVRH was higher than that of TLRH ( P=0.010). Stratify analysis, including stage of disease (Ⅰb1 and Ⅱa1), histologic subtypes (squamous-cell carcinoma, adenocarcinoma), lymph node metastasis, revealed that, ① Stage of disease: in stage Ⅰb1, the OS at five years of mLVRH was higher than that in TLRH group (98.6% vs 93.6%, P=0.012). In stage Ⅱa1, there was significant difference between the two groups, the OS at five years of mLVRH and TLRH were 93.6% and 77.6% ( P=0.007). ② Histologic subtypes: for the OS at five years of squamous-cell carcinoma, mLVRH and TLRH were 96.1% and 92.3%, and there was significant difference ( P=0.046); for adenocarcinoma, the OS at five years were 91.0% and 88.6%, and there was no difference between two groups ( P=0.230). ③ Lymph node metastasis: the mLVRH and TLRH with lymph node metastasis, the OS at five years were 98.6% and 96.4%; the mLVRH and TLRH without lymph node metastasis, the OS at five years were 89.3% and 80.8%. There were no significant differences between the two groups,respectively ( P=0.156, P=0.093). (2) The DFS at 5 years: there was no significant difference between mLVRH and TLRH (94.1% vs 90.9%, P=0.220). Stratify analysis for stage of disease, the mLVRH group was higher than that in the TLRH group in stage Ⅰb1 (97.0% vs 92.8%, P=0.039). However, for stage Ⅱa1, there was no significant difference between mLVRH and TLRH group (88.2% vs 75.8%, P=0.074). Conclusions:The results of this retrospective study indicated that different laparoscopy surgical procedures had diverse oncologic outcomes. The OS at 5 years of the mLVRH is superior to the TLRH. The DFS at 5 years in Ⅰb1 stage, the mLVRH is higher than the TLRH. Therefore, the modified laparoscopy is still an alternative surgery for early cervical cancer patients when following the principle of no-tumor-exposure.
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Objective To investigate the inhibitory effects and possible related mechanism of OTX008 [a selective inhibitor of galectin-1 (Galectin-1)] on retinal neovascularization (RNV) in mouse model of oxygeninduced retinopathy (OIR).Methods 7-day-old (P7) C57BL/6J mice were randomly (according to random number table) divided into 4 groups including normal group,OIR group,OIR-OTX008 group and OIRphosphate buffered saline (PBS) group.To establish the OIR mouse model,mice from all groups except normal group were expose to (75±2)% oxygen for 5 days and then to room air.OIR-OTX008 group received an intravitreal injection of 1 μl (0.25 μg/μl) OTX008 at P12,OIR-PBS group received the equal volume (1 μl) of PBS injection.Mice from 4 groups were euthanized at P17,and retinas were collected for molecular biological analysis and morphological study.RNV was evaluated by counting the number ofpre-retinal neovascular nuclei and the whole-mount immunofluorescent staining of mouse retina.Cyrosections of retinas were imaged via confocal microscopy to observe the enrichment of staining of Galectin-1.Protein levels of Galectin-1,Neuropilin-1 and phosphorylation of vascular endothelial growth factor receptor 2 (pVEGFR2) were determined with Western blot.Results At P17,Galectin-1 expressed higher in retinal ganglion cell layer,inner plexiform layer and inner nuclear layer from OIR group and OIR-PBS group than normal group.Galectin-1 expressed less in cryosection retinas from OIR-OTX008 group than OIR group and OIR-PBS group.The numbers ofpre-retinal neovascular cell nuclei from OIR group and OIR-pBS group were obviously more than that from normal group (t=9.314,P<0.05).The number of pre-retinal neovascular cell nuclei from OIR-OTX008 group were obviously lower than those from OIR group and OIR-PBS group (t=8.038,7.774;P<0.05).The RNV tufts area (t=13.250,12.570),non-perfusion area (t=15.590,12.430) and hypoxic area (t=9.542,9.928) from OIR-OTX008 group were significantly smaller than those in OIR group and OIR-PBS group (P< 0.05).Protein levels of Galectin-1 (t=24.800,23.060),Neuropilin-1 (t=4.120,3.530) and pVEGFR2 (t=25.880,15.480) in the OIR-OTX008 group were significantly down-regulated than those from OIR group and OIR-PBS group (P<0.05).Conclusion Intravitreal injection of OTX008 inhibits RNV and ameliorates retinal hypoxia in mice model of OIR possibly through down-regulating Galectin-1,Neurolinpin-1 and pVEGFR2.
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Objective To explore a 3D printing model of fracture restoration which can be used in preoperative planning and design for distal tibiofibular fractures.Methods A retrospective analysis was performed of the 35 patients with distal tibiofibular fracture who had been treated from October 2015 to September 2016 at our department.Bilateral tibiofibular CT scan was performed in all the cases to obtain Dicom data.Using Mimics 15.0 software,cross sections were created at 5 cm,10 cm and 15 cm above the knee joint at the bilateral upper tibiae and marked as PT5,PT10 and PT15.The long and short axles on the left and right sides were measured and compared (LL vs.RL;LS vs.RS).After the STL files for 3D models were generated using Mimics 15.0 software,a real-sized 3D model of the distal tibiofibular fracture and a mirror model of the contralateral tibiofibula were printed.The fracture lines were drawn and preoperative manoeuvre was performed on the mirror 3D printed model.The real operation used the implants preoperatively designed;the actual screw lengths were measured and compared radiographically with those designed in the preoperative manoeuvre.Results All the data were collected of the long and short axles on the 3 cross-sections (PT5,PT10 and PT15) of the left and right sides of the proximal tibia.The samples were paired into 6 groups.The correlation coefficients of paired samples were greater than 0.95,showing an extremely strong correlation.The differences between the left and right sides showed no statistically significance in paired samples of LR-RL and LS-RS groups on PT5,PT10 and PT15 cross-sections (P > 0.05).All the 35 cases received surgical operation.The postoperative X-ray review showed fine agreement between actual surgery and preoperative design in terms of screw length and accuracy.The deviations were in an allowable range,leading to satisfactory internal fixation.Conclusions A mirror 3D model of the healthy side is of clinical value to some extent because it can serve as one for an anatomically reduced fracture which can be used for preoperative manoeuvre and preparation of implants.The contrasts between the long and short axles on the 3 cross-sections may simplify and facilitate comparisons of bilateral similarity,avoid the blindness in direct application of the health side mirror model for preoperative planning.
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Objective To study the effect of clinical nursing path with graph and text instructions (GTI) on health education to patients with complex retinal detachment.Methods Toally 76 inpatients with complex retinal detachment were enrolled in the study:38 of them hosptalized from March to August 2015 were put in the control group received routine treatment and the others hosptalized from September 2015 to March 2016 as the experiment group treated with GTI.The clinical outcomes were compared.Result The patients treated with GTI were better in the knowledge of the complex retinal detachment and moreover,they felt significantly more satisfied compared to that of the control group (P<0.05).Conclusion It is beneficial to use GTI in the patients with complex retinal detachment.GTI is effective for improving their knowledge on the disease,and increasing their satisfaction with the clinical nursing.