摘要
OBJECTIVE@#To observe the cage subsidence after oblique lateral interbody fusion (OLIF) for lumbar spondylosis, summarize the characteristics of the cage subsidence, analyze causes, and propose preventive measures.@*METHODS@#The data of 144 patients of lumbar spine lesions admitted to our hospital from October 2015 to December 2018 were retrospectively analyzed. There were 43 males and 101 females, and the age ranged from 20 to 81 years old, with an average of (60.90±10.06) years old. Disease types:17 patients of lumbar intervertebral disc degenerative disease, 12 patients of giant lumbar disc herniation, 5 patients of discogenic low back pain, 33 patients of lumbar spinal stenosis, 26 patients of lumbar degenerative spondylolisthesis, 28 patients of lumbar spondylolisthesis with spondylolisthesis, 11 patients of adjacent vertebral disease after lumbar internal fixation, 7 patients of primary spondylitis in the inflammatory outcome stage, and 5 patients of lumbar degenerative scoliosis. Preoperative dual-energy X-ray bone mineral density examination showed 57 patients of osteopenia or osteoporosis, and 87 patients of normal bone density. The number of fusion segments:124 patients of single-segment, 11 patients of two-segment, 8 patients of three-segment, four-segment 1 patient. There were 40 patients treated by stand-alone OLIF, and 104 patients by OLIF combined with posterior pedicle screw. Observed the occurrence of fusion cage settlement after operation, conducted monofactor analysis on possible risk factors, and observed the influence of fusion cage settlement on clinical results.@*RESULTS@#All operations were successfully completed, the median operation time was 99 min, and the median intraoperative blood loss was 106 ml. Intraoperative endplate injury occurred in 30 patients and vertebral fracture occurred in 5 patients. The mean follow-up was (14.57±7.14) months from 6 to 30 months. During the follow-up, except for the patients of primary lumbar interstitial inflammation and some patients of lumbar spondylolisthesis with spondylolisthesis, the others all had different degrees of cage subsidence. Cage subsidence classification:119 patients were normal subsidence, and 25 patients were abnormal subsidence (23 patients were gradeⅠ, and 2 patients were gradeⅡ). There was no loosening or rupture of the pedicle screw system. The height of the intervertebral space recovered from the preoperative average (9.48±1.84) mm to the postoperative average (12.65±2.03) mm, and the average (10.51±1.81) mm at the last follow-up. There were statistical differences between postoperative and preoperative, and between the last follow-up and postoperative. The interbody fusion rate was 94.4%. The low back pain VAS decreased from the preoperative average (6.55±2.2 9) to the last follow-up (1.40±0.82), and there was statistically significant different. The leg pain VAS decreased from the preoperative average (4.72±1.49) to the final follow-up (0.60±0.03), and the difference was statistically significant (t=9.13, P<0.000 1). The ODI index recovered from the preoperative average (38.50±6.98)% to the latest follow-up (11.30±3.27)%, and there was statistically significant different. The complication rate was 31.3%(45/144), and the reoperation rate was 9.72%(14/144). Among them, 8 patients were reoperated due to fusion cage subsidence or displacement, accounting for 57.14%(8/14) of reoperation. The fusion cage subsidence in this group had obvious characteristics. The monofactor analysis showed that the number of abnormal subsidence patients in the osteopenia or osteoporosis group, Stand-alone OLIF group, 2 or more segments fusion group, and endplate injury group was higher than that in the normal bone mass group, OLIF combined with pedicle screw fixation group, single segment fusion group, and no endplate injury group, and the comparison had statistical differences.@*CONCLUSION@#Cage subsidence is a common phenomenon after OLIF surgery. Preoperative osteopenia or osteoporosis, Stand-alone OLIF, 2 or more segments of fusion and intraoperative endplate injury may be important factors for postoperative fusion cage subsidence. Although there is no significant correlation between the degree of cage subsidence and clinical symptoms, there is a risk of cage migration, and prevention needs to be strengthened to reduce serious complications caused by fusion of cage subsidence, including reoperation.
Subject(s)
Male , Female , Humans , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Spondylolisthesis/surgery , Retrospective Studies , Low Back Pain/etiology , Scoliosis , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Bone Diseases, Metabolic , Osteoporosis/etiology , Treatment Outcome , Intervertebral Disc Displacement , Intervertebral Disc Degeneration摘要
Objective To analyze the acupoint selection rules of acupuncture for the treatment of tic disorders in children based on data mining techniques.Methods A computerized search was conducted for the clinical research literature on acupuncture treatment of tic disorders in children included in the CNKI,Wanfang,VIP,SinoMed,and PubMed databases from January 1992 to December 2022.A database was established by Excel 2019 to count the commonly used treatment methods and analyze the high-frequency application methods acupuncture(high-frequency acupoints,channel entry of acupoints,acupoint association rules,and acupoint clustering),auricular point seed-pressing(high-frequency auricular points,and acupoint association rules),and the high frequency division of cluster needling of scalp point.Results A total of 190 valid literature articles were included,involving 270 acupuncture prescriptions;among them,184 acupoints were counted in the acupuncture method,with a total application frequency of 1 906 times,and the high-frequency application of the acupoints in descending order were Baihui(DU20),Taichong(LR3),Fengchi(GB20),Hegu(LI4),Sanyinjiao(SP6),Neiguan(PC6),Shenmen(HT7),Zusanli(ST36),Yintang(EX-HN3),Sishencong(EX-HN1);and the high-frequency meridians were governor vessol,foot taiyang stomach meridian,foot taiyang stomach meridian,foot shaoyang gallbladder meridian,hand taiyang large intestine meridian,foot taiyang bladder meridian,foot jueyin gallbladder meridian;three sets of strong association rules and five clusters of acupoints were analyzed by SPSS modeler 18.0 and IBM SPSS Statistics 26.0 software.There were 29 acupoints of auricular point seed-pressing,application total frequency was 206 times,high-frequency application of auricular points in descending order of Shenmen(HT7),liver,heart,subcortex,kidney;four groups of acupoint strong association rules were obtained through the analysis of SPSS modeler 18.0 software.A total of 14 zones were involved in the application of cephalic acupoint plexus zoning,of which the high-frequency zones were parietal anterior temporal diagonal,parietal parietal 1,and chorea tremor control zone.Conclusion Acupuncture treatment of tic disorders in children,according to its pathogenesis(liver hyperactivity,kidney depletion,spleen deficiency,phlegm disturbance,etc.)and tic site,select acupoints compatibility,and mostly choose yang meridian acupoints,which is related to the nature and treatment characteristics of wind pathogen.Children's tic disorders are closely related to emotional disorders,therefore acupuncture and auricular acupoints all emphasize the method of soothing the liver and clearing the heart,and regulating the emotional state.Cluster needling of scalp point mostly used parietal temporal anterior oblique line,parietal 1 line,and dance tremor control area for the treatment of tic disorders.For children,auricular point seed-pressing and cluster needling of scalp point has the minimun of pain,the effect of treatment is long,and it is not easy to have dangerous situations such as bent needle,broken needle and so on.
摘要
OBJECTIVE@#To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.@*METHODS@#A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed.@*RESULTS@#There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved.@*CONCLUSION@#As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.
Subject(s)
Male , Female , Humans , Child, Preschool , Intervertebral Disc Degeneration/surgery , Retrospective Studies , Sclerosis , Treatment Outcome , Lumbar Vertebrae/surgery , Spinal Fusion/methods摘要
OBJECTIVE@#To analyze the causes of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy, summarize the clinical results, and propose preventive measures.@*METHODS@#Retrospective analysis was made on the data of 8 cases of lumbar spondylopathy and vertebral fracture treated by oblique lateral interbody fusion in three medical centers from October 2014 to December 2018. All were female, aged from 50 to 81 years with an average of 66.4 years. Disease types included 1 case of lumbar degenerative disease, 3 cases of lumbar spinal stenosis, 2 cases of lumbar degenerative spondylolisthesis and 2 cases of lumbar degenerative scoliosis. Preoperative dual energy X-ray bone mineral density test showed that 2 cases had T-value >-1 SD, 2 cases had T-value -1 to -2.5 SD, and 4 cases had T-value <-2.5 SD. Single segment fusion was in 5 cases, two segment fusion in 1 case and three segment fusion in 2 cases. Four cases were treated with OLIF Stand-alone and 4 cases were treated with OLIF combined with posterior pedicle screw fixation. Postoperative imaging examination showed vertebral fracture, and all of them were single vertebral fracture. There were 2 cases of right lower edge fracture of upper vertebral body at fusion segment, 6 cases of lower vertebral body fracture at fusion segment, and 6 cases with endplate injury and fusion cage partially embedded in vertebral body. Three cases of OLIF Stand-alone were treated with pedicle screw fixation via posterior intermuscular approach, while one case of OLIF Stand-alone and four cases of OLIF combined with posterior pedicle screw fixation were not treated specially.@*RESULTS@#The 5 cases of initial operation and 3 cases of reoperation did not show wound skin necrosis or wound infection. The follow-up time was from 12 to 48 months with an average of 22.8 months. Visual analogue scale (VAS) of low back pain was preoperative decreased from 4 to 8 points (averagely 6.3 points) and postoperative 1 to 3 points (averagely 1.7 points) at the final follow-up. Oswestry disability index (ODI) was preoperative 39.7% to 52.4% (averagely 40.2%), and postoperative 7.9% to 11.2% (averagely 9.5%) at the final follow-up. During the follow-up, there was no loosening or fracture of the pedicle screw system, and no lateral displacement of the fusion cage;however, the fusion cage at the vertebral fracture segment had obvious subsidence. The intervertebral space height of vertebral fracture segment was preoperaive 6.7 to 9.2 mm (averagely 8.1 mm), and postoperative 10.5 to 12.8 mm (averagely 11.2 mm). The improvement rate after operation was 37.98% compared to preoperative. The intervertebral space height at final follow-up was 8.4 to 10.9 mm (averagely 9.3 mm), and the loss rate was 16.71% compared with that after operation. At the final follow-up, interbody fusion was achieved in all cases except for one that could not be identified.@*CONCLUSION@#The incidence of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy is lower, and there are many reasons for fracture, including preoperative bone loss or osteoporosis, endplate injury, irregular shape of endplate, excessive selection of fusion cage, and osteophyte hyperplasia at the affected segment. As long as vertebral fracture is found in time and handled properly, the prognosis is well. However, it still needs to strengthen prevention.
Subject(s)
Humans , Female , Male , Spinal Fractures/surgery , Retrospective Studies , Treatment Outcome , Lumbar Vertebrae/surgery , Spondylolisthesis/surgery , Scoliosis , Spinal Fusion/methods摘要
Immunosuppression is a key element of poor prognosis in patients with sepsis. The immune status assessment is a prerequisite for identifying immunosuppressed patients and clarifying the timing of immunotherapy. Exploring biomarkers for immune status assessment in sepsis has become a current hot spot. However, the availability of a large number of biomarkers in recent years has presented clinicians with a selection problem. There is four criteria for ideal biomarkers of sepsis immunosuppression for the screening of potential biomarkers of sepsis immunosuppression.
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Objective:To investigate the effects of endocrine drugs on tumor markers and endometrium after breast cancer surgery.Methods:Eighty-eight patients with endocrine therapy for breast cancer admitted to the Heping Hospital Affiliated to Changzhi Medical College from November 2018 to March 2022 were selected, 44 patients taken orally tamoxifen citrate tablets were enrolled in the study group, 44 patients taken orally anastrozole tablets were enrolled in the control group, the patients in the two groups were treated for 12 months. The tumor markers, endometrial thickness were compared between the two groups before treatment and 12 months after treatment. The drug safety was compared too.Results:After treatment, the serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and glycochain antigen 15-3 (CA15-3) in both groups were decreased, and the level of tumor markers in the study group were lower than those in the control group: (3.01 ± 0.23) μg/L vs.(3.89 ± 1.15) μg/L, (4.22 ± 1.21) kU/L vs. (7.38 ± 2.19) kU/L, (16.76 ± 2.19) kU/L vs. (19.87 ± 2.21) kU/L, there were statistical differences ( P<0.05). The endometrial thickness in the study group at 6 months and 12 months after treatment were higher than those in the control group: (7.23 ± 0.22) mm vs. (6.21 ± 0.19)mm, (7.98 ± 0.24) mm vs. (6.47 ± 0.22) mm, there were statistical differences ( P<0.05). At 12 months after treatment, the scores of functional dimension, emotional dimension, social/family dimension and physical dimension in functional assessment of cancer therapy (FACT-G) scale in the study group were significantly higher than those in the control group ( P<0.05). There was no statistically significant difference in adverse reactions between the two groups ( P>0.05). Conclusions:Tamoxifen citrate tablets can effectively inhibit the levels of serum tumor markers and improve the quality of life of patients, and anastrozole tablets can significantly reduce the endometrial thickness of breast cancer patients.
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There are many multi-original medicinal materials in Chinese Pharmacopoeia, and the mixed use of medicinal materials from different sources is common, which has certain influence on the stability of clinical medication. In this study, pyrosequencing technology was used to screen species-specific single nucleotide polymorphisms (SNP) from commonly used DNA barcode sequences, and a rapid and accurate molecular identification method for original species in mixed medicinal powder of Epimedii Folium was established. Multiple sequence alignment analysis showed that the 176th (C/T) mutation and the 196th (A/G) mutation of ITS, the 123rd (C/G) mutation of matK and the 892nd (A/C) mutation of rbcL could be used as the unique SNPs of E. sagittatum, E. koreanum, E. brevicornu and E. pubescens, respectively. In this study, the applicability of pyrosequencing and Sanger sequencing methods in the sequencing of mixture samples was investigated from the perspective of sensitivity and stability. Pyrosequencing method has higher detection sensitivity than Sanger sequencing method for low content samples in the mixed samples. Stability analysis showed that pyrosequencing technology could still obtain effective sequencing results for the amplified products of template DNA after 45 min of 95 ℃ high temperature water bath, while the critical point of Sanger sequencing method was 30 min. In this study, a new identification technology of Epimedii Folium mixed powder primordial species based on pyrosequencing and specific SNP was developed, which can quickly and accurately identify the mixed use of Epimedii Folium with high sensitivity and stability, and can also support the identification of different primordial species and mixed powder primordial herbs, which is conducive to ensuring the consistency and stability of clinical medication.
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Objective:To explore the feasibility and clinical efficacy of oblique lateral interbody fusion (OLIF) in the treatment of adjacent segment disease (ASDis).Methods:Retrospective analysis was conducted on the data of 31 patients with ASDis treated by OLIF in four medical centers from June 2015 to December 2018. There were 17 males and 14 females. The average age was (65.7±3.4) years (range, 59 to 75 years). 19 cases received single-segment fixed fusion, 11 cases received double-segment fixed fusion and 1 case received three-segment fixed fusion. Original fixed fusion site: 1 case of L 1, 2, 3 cases of L 3, 4, 11 cases of L 4, 5, 4 cases of L 5S 1, 6 cases of L 3-L 5, 5 cases of L 4-S 1, and 1 case of L 3-S 1. The time from the initial fixation and fusion to this admission was 82.5±45.5 months (rang, 24 to 180 months). ASDis occurred at the proximal end of the fixed fusion segment in 28 cases and at the distal end in 3 cases. The types of ASDis: degenerative disc disease in 11 cases, lumbar spinal stenosis in 15 cases, degenerative spondylolisthesis in 2 cases, and degenerative scoliosis in 3 cases. The location of ASDis: 6 cases of L 2, 3, 12 cases of L 3, 4, 6 cases of L 4, 5, 3 cases of L 1-L 3, 1 case of L 2-L 4, and 3 cases of L 1-L 4. At admission, 3 cases of lumbar internal fixation had been removed and 28 cases of internal fixation remained. Stand-alone OLIF was performed in 19 cases, OLIF combined with pedicle screw fixation in 8 cases, and OLIF combined with cortical screw fixation in 4 cases. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the low back pain and lumbar function before operation and at the last follow-up, and the imaging results and complications were observed. Results:All patients were followed up. The follow-up time was 23.6±9.6 months (range, 12 to 60 months). The operation time was 73.8±25.3 mins (range, 40 to 180 min), and the intraoperative blood loss was 86.2±67.4 ml (range, 20 to 310 ml). The average blood loss in each segment was 24.8 ml. During the operation, there were 1 case of segmental vein injury, 7 cases of endplate injury, 2 cases of transient iliopsoas muscle weakness, 1 case of thigh pain and numbness, and 1 case of incomplete intestinal obstruction. There was no incision necrosis and infection. The VAS score of low back pain decreased from 5.9±1.9 before operation to 1.4±0.6 at the last follow-up, with a statistically significant difference ( t=8.47, P<0.001). The ODI index recovered from 45.2%±5.7% before operation to 13.8%±4.7% at the last follow-up, with a statistically significant difference ( t=7.92, P<0.001). The height of intervertebral space increased from 8.7±1.6 mm before operation to 11.4±1.9 mm after operation and 9.9±1.8 mm at the last follow-up. There was a statistically significant difference between postoperative and preoperative height of intervertebral space ( F=4.15, P=0.007). There was a statistically significant difference between the last follow-up and postoperative height of intervertebral space ( P=0.011). During the follow-up, there were 13 cases of fusion cage subsidence, 1 case of fusion cage displacement, and no case of internal fixation loosening or fracture. The intervertebral fusion rate was 94%(29/31) and the complication rate was 42%(13/31). Conclusion:ASDis is a common complication after lumbar fixation and fusion, and requires surgical treatment. OLIF is a reliable method to treat ASDis as it has advantages of small trauma, high fusion rate and low complication rate.
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Objective:To investigate the clinical effect of laparoscopic common bile duct exploration through Micro-incision of cystic duct and its junction in for choledocholithiasis.Methods:The clinical data of 62 patients with cholecystolithiasis complicated with choledocholithiasis treated in the Department of hepatobiliary and pancreatic surgery of Huangshi Central Hospital, Edong Healthcare Group from January 2017 to December 2021 were analyzed retrospectively, and were divided into two groups according to different treatment schemes. Among them, 32 cases underwent laparoscopic cholecystectomy, common bile duct exploration and lithotomy (primary suture group), Laparoscopic choledocholithotomy and exploration + T-tube drainage (T-tube Drainage Group) 30 cases. The general data, operation time, intraoperative bleeding, postoperative exhaust time, first time out of bed, postoperative hospital stay, 24-hour postoperative pain score and the incidence of total complications were compared between the two groups.Results:The operation was successfully performed in both groups, there was no perioperative death.There was no significant difference in general data, operation time, intraoperative bleeding and the incidence of total complications between the two groups ( P> 0.05), the postoperative anal exhaust time, the first time out of bed and the postoperative hospital stay in the primary suture group were (20.3±5.8) h, (15.5±4.3) h and (4.5±1.7) d, respectively, which were significantly shorter than those in the T-tube drainage group (28.3±7.9) h, (22.8±6.7) h and (7.0±2.8) d( P<0.05); The hospitalization cost in the primary suture group was (18 725.9±855.8) yuan, which was significantly lower than that in the T-tube drainage group (23 450.7±975.4) yuan ( P< 0.05). The 24-hour pain score (2.7±0.9) scores in the primary suture group was significantly lower than that in the T-tube drainage group (3.8±1.2) scores ( P< 0.05). Conclusion:Laparoscopic common bile duct exploration through micro-incision of cystic duct and its junction is safe and effective, which can accelerate the rehabilitation of patients and reduce the cost of hospitalization, which is more in line with the concept of ERAS.
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@#Obective To analyze the risk factors during pregnancy and perinatal period leading to attention deficit hyperactivity disorder (ADHD) in children using scoping review. Methods The literatures related to the risk factors of children's ADHD during pregnancy and perinatal period were searched from CNKI, Wanfang Data, PubMed and Web of Science, from the establishment to July 1st, 2021. The content of author, country, publication time, research object, age, sample size, inclusion time, study design, diagnostic criteria, evaluation tools and related risk factors were extracted. Results A total of 2 721 articles were returned, and 35 articles were finally included, from eleven countries. Most of the articles came from journals related to pediatrics, psychiatry, neurology and epidemiology. The researches were mainly concentrated from 2008 to 2021, mainly were controlled studies and cohort studies. The researches mainly involved the methods of diagnosis, evaluation of risk factors during pregnancy and perinatal period, and related risk factors. The diagnostic criteria of ADHD mainly were the Diagnostic and Statistical Manual of Mental Disorders and International Disease Classification Standards, combined with the questionnaires used by parents and teachers to make the final diagnosis. The risk factors during pregnancy and perinatal period were extracted from medical records of birth, birth records, maternal medical history, perinatal hospitalization and outpatient records, and maternal drug use records during pregnancy, or questionnaire survey (parents/newborns). The risk factors for ADHD in children during pregnancy and perinatal period might be divided into four aspects: maternal factors, intrauterine factors, environmental factors and perinatal accidents. Among them, the maternal factors included young mother, obesity, poor living behavior, substance exposure, medical history, and nutrient deficiency during pregnancy; intrauterine factors included poor fetal development in the mother's uterus, miscarriages and the number of pregnancies; environmental factors included living environment and social environment; perinatal accidents included childbirth accidents and poor health of newborns. Conclusion The pregnancy and perinatal risk factors related to ADHD in children mainly include maternal factors, intrauterine factors, environmental factors and perinatal accidents. The poor mental health of mothers during pregnancy is the main risk factor leading to children's ADHD.
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@#Objective To perform a visualized analysis of the current status, hotspots and frontiers of research on denervated muscle atrophy in the past five years.Methods The Web of Science core database was used to retrieve relevant documents in the field of denervated muscle atrophy, and visualized analysis was performed on CiteSpace 5.8.R3 in terms of annual number of published papers, frequency of citations, countries, institutions, authors, keywords and references.Results A total of 516 articles were retrieved from 2017 to 2021. The annual number of published papers was on the rise, and the number of citations was increasing year by year. The United States, Canada and England were high-influence countries, the University of Padua in Italy was the leading institution. The author SUN Hualin published the most articles. The authors Bodine S C and Sandri M were the main influencers. Physiological and pathological mechanisms based on cytology, molecular biology and tissue morphology, as well as prevention and treatment measures based on physical factor therapy, drugs and exercise were the research hotspots in this field. It might be coming that taking reactive oxygen species as the target and looking for multi-targeted proteolytic system drugs as the goal for prevention and treatment.Conclusion This visualized analysis has comprehensively summarized the trends and development of denervated muscle atrophy research, and identified the potential research frontiers and hot directions in the near future.
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OBJECTIVES@#To investigate the psychological and behavioral problems and related influencing factors in children and adolescents during the coronavirus disease 2019 (COVID-19) epidemic.@*METHODS@#China National Knowledge Infrastructure, Wanfang Data, PubMed, and Web of Science were searched using the method of subject search for articles published up to March 31, 2022, and related data were extracted for Scoping review.@*RESULTS@#A total of 3 951 articles were retrieved, and 35 articles from 12 countries were finally included. Most of the articles were from the journals related to pediatrics, psychiatry, psychology, and epidemiology, and cross-sectional survey was the most commonly used research method. Psychological and behavioral problems in children and adolescents mainly included depression/anxiety/stress, sleep disorder, internet behavior problems, traumatic stress disorder, and self-injury/suicide. Influencing factors were analyzed from the three aspects of socio-demographic characteristics, changes in living habits, and ways of coping with COVID-19.@*CONCLUSIONS@#During the COVID-19 epidemic, the psychological and behavioral problems of children and adolescents in China and overseas are severe. In the future, further investigation and research can be carried out based on relevant influencing factors to improve the psychological and behavioral problems.
Subject(s)
Adolescent , Child , Humans , Anxiety/etiology , COVID-19 , China/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Mental Health , Problem Behavior摘要
OBJECTIVE@#To explore the clinical value and safety of unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion by muscle-splitting approach treatment of recurrent lumbar disc herniation.@*METHODS@#The clinical data of 51 patients with recurrent lumbar disc herniation treated from June 2012 to December 2017 were retrospectively analyzed. There were 32 males and 19 females, aged 34 to 64 years with an average of (51.11± 7.28) years. Lesions invoved L@*RESULTS@#There was no statistical difference in operation time between two groups (@*CONCLUSION@#Muscle-splitting approach is feasible for thetreatment of recurrent lumbar disc herniation with pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion. Compared with the median incision approach, the muscle-splitting approach has the advantages of small incision, less trauma, less bleeding, rapid recovery. Also it can protect multifidus and do not increase the incidence of serious complications. Thus, it can be used as a choice for fixation and fusion of recurrent lumbar disc herniation.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Intervertebral Disc Degeneration , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Muscles , Pedicle Screws , Retrospective Studies , Spinal Fusion , Treatment Outcome摘要
Objective: To investigate the effect of bare-metal stent related technique on distal aortic dissection involving abdominal visceral segment. Methods: A retrospective analysis was performed on clinical data of 33 patients with distal aortic dissection involved abdominal visceral segment, who hospitalized in the Vascular Surgery Department of Shanghai Changhai Hospital from July 2012 to September 2019. The effect of the treatment was evaluated according to the clinical and preoperative, intraoperative and follow-up imaging data derived from (aorta computed tomography angiography (CTA) and digital subtraction angiography (DSA)) as well as the changes of the maximal diameter of the aorta and the thrombosis of the false lumen of the dissection. The criteria were as follows: the maximum diameter change of aortic dissection<5 mm was defined as stable; the maximum diameter decrease of aortic dissection≥5 mm was defined as effective reduction; the maximum diameter increase of aortic dissection≥5 mm was defined as expansion; the definition of diameter change of false lumen was the same as above. The hospital complications, clinical symptoms and survival were recorded. Results: There were 28 male patients in this cohort, the mean age was (57.6±4.9) years old. Twenty-one patients were treated with bare-metal stent and coils technique, of which 8 patients were jointly treated with stent grafts. Twelve patients were treated with multi-layer bare-metal stent technique, of which 4 patients were jointly treated with stent grafts. Intraoperative DSA image results showed that the visceral arteries were patent during the treatment, and the blood flow velocity of the false lumen was reduced in all 33 patients. There were no adverse events such as distal outflow tract embolism and coil displacement during the operation. During the period of hospitalization, one patient developed intimal rupture of subrenal abdominal aortic dissection on the fourth day after operation and emergency endovascular graft exclusion was performed for abdominal aortic dissection, and the patient recovered well from the emergency operation. The follow-up time was (16.7±14.0) months. One patient died 1 year after surgery due to non-disease-related factors. Follow-up CTA imaging results showed that the maximum diameter of the aorta in abdominal visceral segment tended to be smaller ((39.1±13.4) mm vs. (41.3±11.9) mm, P=0.469), and the maximum diameter of the false lumen was significantly reduced ((16.2±12.9) mm vs. (23.5±10.7) mm, P=0.014). The maximum diameter of the aortic dissection was reduced in 12 cases, stable in 19 cases, expanded in 2 cases. The maximum diameter of the false lumen was effectively reduced in 22 cases, stable in 10 cases, and expanded in 1 case. Four patients developed small endoleak in the false lumen, one of them was nearby the renal artery stent, and the remaining patients experienced complete thrombosis of the false lumen. Conclusions: Endovascular treatment of distal aortic dissection involving abdominal visceral segment with bare-metal stents related technique could promote the shrink and the thrombosis of the false lumen, and slow down the blood flow from the tear into the false lumen in the setting of patency of visceral arteries.
Subject(s)
Humans , Male , Middle Aged , Aortic Dissection/surgery , Aortic Aneurysm, Thoracic/surgery , Aortography , Blood Vessel Prosthesis Implantation , China , Endovascular Procedures , Retrospective Studies , Stents , Treatment Outcome摘要
Objective: To develop a set of data elements and standardized definitions of Coronary Artery Disease and Creative Antithrombotic Clinical Research Collaboration (CardiaCare), aiming to facilitate the exchange of disparate data sources, enhance the abilities to support multicenter researches, and subsequently ensure the databases use under standardized process and criteria. Methods: The Cardiacare writing committee members reviewed data elements and definitions from published guidelines, clinical trials, databases, and standardized documents, then determined the data elements and standardized definitions, which should be included in CardiaCare. The writing committee also considered the specific domestic clinical management strategies during the establishment of Cardiacare. The resulting documents provide a series of key data elements and standardized definitions used in the management of coronary artery disease patients. Key data elements from CardiaCare could be sorted by clinical management flowsheet and outcome from hospitalization to long-term follow-up. Results: The Cardiacare standardized set comprised 864 data elements from admission to post-hospital follow-up visit. There were 8 tables in the documents, including demographic and admission information (23 elements), medical history and risk factors (102 elements), clinical presentations and diagnosis (22 elements), diagnostic and laboratory tests (111 elements), interventional diagnosis and treatment (118 elements), pharmacological therapy (213 elements), clinical outcomes (161 elements), and special subpopulations (114 elements: 87 elements for transcatheter valve replacement and 27 elements with cardiac rehabilitation). Conclusions: The Cardiacare standardized data elements set could provide support for real-world clinical research in consecutive data collection and databases mining. A wider applicability in various settings of CardiaCare needs to be explored further.
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Humans , Cardiac Rehabilitation , Coronary Artery Disease/drug therapy , Fibrinolytic Agents摘要
Objective To evaluate the clinical value of compound bone peptide injection in patients with thoracolumbar osteoporotic fracture. Methods 96 patients admitted from January 2018 to January 2020 with thoracolumbar osteoporotic fracture were selected. The patients were randomly divided into group A (receiving calcine D with compound bone peptide injection) and group B (receiving calcine D treatment) with 48 patients in each group. TCM symptom scores, bone metabolism, degree of osteoporosis, bone density level, visual analogue scale (VAS) and lumbar spine disease treatment score (JOA) were compared between the two groups after treatment. Results After treatment, the TCM symptom score and JOA score in group A were higher than those in group B (P<0.05). The levels of bone alkaline phosphatase (BALP) and type I procollagen N-terminal propeptide (PIINP) in group A were significantly lower than those in group B (P<0.05). The grade 3 osteoporosis ratio in group A was lower than that in group B (P<0.05). The bone mineral density level in group A was higher than that in group B (P<0.05). The visual analogue scale (VAS) in group A was lower than that in group B (P<0.05). Conclusion The treatment of thoracolumbar osteoporotic fracture with compound bone peptide injection effectively improved the bone metabolism and bone mineral density, relieved pain and promoted the recovery of lumbar function.
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Objective:To explore the feasibility, safety and early prognosis of laparoscopic choledocholithotomy in patients with previous history of upper abdominal surgery.Methods:From January 2014 to December 2018, the clinical data of 156 patients with previous history of upper abdominal surgery in hepatobiliary and pancreatic surgery of Central Hospital of Edong Healthcare Group were analyzed retrospectively. Among them, 84 cases with laparoscopic common bile duct exploration and stone extraction were allocated into laparoscopic group, 72 cases with open common bile duct exploration and stone extraction were allocated into open group.In the laparoscopic group, there were 50 males and 34 females, aged 42-83 (66.4±17.8) years; In the open group, there were 40 males and 32 females, aged 45-82 (64.2±16.9) years. The operation time, intraoperative hemorrhage, first defecation time and postoperative hospital stay were compared between the two groups. The postoperative pain score and the incidence of early complications (bile leakage, abdominal distention, ascites, epigastric pain, residual stones) were compared between the two groups. The measurement data subject to normal distribution are represented by ( Mean± SD), the independent sample t test was used for group comparison, and the chi-square test was used for counting data comparison. Results:The laparoscopic group was converted to open surgery in 3 cases, and there was no perioperative death. In the laparoscopic group, the operation time, the intraoperative bleeding volume, the first defecation time, the postoperative hospital stay wee (122.8 ± 28.1) min, (80.3 ± 13.7) mL, (1.8 ± 0.3) d, (7.7 ± 0.8) d, and (146.6 ± 33.5) min, (125.8 ± 19.6) mL, (2.7 ± 0.6) d, (9.1± 1.2) d in the open group; The difference between the two groups was statistically significant ( P<0.05); On the 2nd and 4th day after operation, the abdominal pain scores in laparoscopic group were (3.6 ± 1.3) scores and (2.3 ± 0.7) scores, and (5.5±1.6) scores, (4.2±1.3) scores in the open group, the laparoscopic group were significantly lower than those in the open group ( P<0.05); The incidence of early postoperative complications in the laparoscopic group was 32.1% (27/84), and in the open group was 47.2% (34/72), but the difference was not statistically significant ( P>0.05). Conclusions:For patients with a history of upper abdominal surgery, laparoscopic common bile duct exploration and choledochoscopy are safe and feasible, The operation has the advantages of minimally invasive and less bleeding, which can relieve postoperative pain, shorten postoperative hospital stay, and will not increase the incidence of postoperative complications, It′s good for quick recovery. It is suitable for the promotion of grass-roots hospitals.
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OBJECTIVE@#To explore the clinical effect of combined fixation and interbody bone grafting through intermuscular approach with different fusion cages in the treatment of single segment lumbar diseases.@*METHODS@#From June 2014 to December 2016, the clinical data of 123 cases of single segment lumbar diseases were analyzed retrospectively, including 44 males and 79 females, aged 22 to 60 years old, with the diseases course of 6 to 84 months. The disease types involved lumbar disc degeneration in 65 cases, lumbar spinal stenosis in 30 cases, MeyerdingⅠslip in 21 cases, giant lumbar disc herniation in 7 cases. Lesions was L in 5 cases, L in 101 cases, LS in 17 cases. According to the application of different interbody fusion cage, patients were divided into single common cage group, double common cage group and banana type cage group. The operation time, intraoperative hemorrhage, postoperative incision drainage fluid and incision length were observed in three groups; VAS score of lumbar incision and JOA score of preoperative and final follow up were recorded 72 hours after operation;the intervertebral space height, Cobb angle of lumbar coronal and sagittal plane before and after operation, and interbody fusion 12 months after operation were observed by imaging data.@*RESULTS@#There was no significant difference in incision length, operation time, intraoperative bleeding volume, postoperative drainage volume and VAS score of lumbar incision 72 hours after operation among three groups (>0.05). All cases were followed up for 12 to 36 (23.70±4.52) months. The height of intervertebral space in three groups recovered significantly (banana type fusion cage group>double common fusion cage group. At the last follow-up, the Cobb angle in the coronaland sagittal planes of the three groups were significantly improved (<0.05). During the follow-up, there were 42 cases of fusion cage subsidence, including 26 cases in the single common cage group, 5 cases in the double common cage group, 11 cases in the banana cage group, the difference was statistically significant (<0.05). At 12 months after operation, the interbody fusion rate was 83% in the single common cage group, 95% in the double common cage group and 90% in the banana cage group, the interbody fusion rate in the two common cage group and the banana cage group was better than that in the single common cage group. No obvious degeneration was observed in the adjacent segments. At the last follow-up, the JOA scores of the three groups were statistically significant (<0.05). The incidence of single common fusion cage group was 10%(4 / 42), that of double common fusion cage group was 9%(4 / 43), and that of banana fusion cage group was 10%(4 / 39). There was no significant difference among the three groups.@*CONCLUSION@#Through the intermuscular approach, single pedicle screw and contralateral facet screw were used for fixation, and single common fusion cage, double common fusion cage or banana type fusion cage were used for interbody grafting to treat single segment lumbar disease. Although the application of different fusion cage could not increase the axial strength of fixed segment, the speed of fusion was accelerated by increasing the contact area, and the quality of the fusion cage reduces the settlement of the cage and the loss of the height of the intervertebral space. Therefore, two interbody fusion cages implanted in one side are of positive clinical significance for the fixation of unilateral pedicle screw combined with contralateral facet screw, without prolonging the operation time and increasing the complications.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Case-Control Studies , Intervertebral Disc Degeneration , General Surgery , Lumbar Vertebrae , Retrospective Studies , Spinal Fusion , Treatment Outcome摘要
The suboccipital muscle group has been paid more and more attention by the rehabilitation community. Its special junction and special structure make many diseases and symptoms have important association with it. This article will introduce the research progress of suboccipital muscle group from four parts: anatomy, physiological function, common cause of injury and clinical application.
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Objective:To compare the clinical outcomes and complications of oblique lateral interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach and posterior interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach by channel for lumbar spinal stenosis.Methods:A retrospective study was conducted on 73 patients who underwent surgical treatment for lumbar spinal stenosis from Jun 2015 to Jun 2017, including 33 males and 40 females. The average age was 66.8±7.94 years (from 39-85 years). These diseases occured at L 3/4 in 5 patients and L 4/5 in 68 patients. Random according to the time of admission, 38 cases were treated with oblique lateral interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach (oblique lateral fusion group), and 35 cases with posterior interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach by channel (posterior fusion group). The clinical results, image data and complications were compared between the two groups. Results:All patients in both groups had operation performed smoothly. The operation time was 99±8.96 min in the oblique lateral fusion group and 96.8±9.57 min in the posterior fusion group, and there was no significant difference between the two groups. The intraoperative bleeding in the oblique lateral fusion group 80±24.72 ml was significantly less than that in the posterior fusion group 261±52.87 ml ( t=9.621, P<0.05). No incision infection occurred after surgery. The VAS score of lumbar incision 72h after operation in the oblique lateral fusion group 1.21±0.55 was significantly less than that in the posterior fusion group 1.70±0.86 ( t=3.723, P=0.028). The follow-up period lasted for 12-24 months, averagely 17.5±2.58 months. There was statistically significant difference between preoperative and postoperative in the two groups, whether it was the area of the foraminal canal or the area of the spinal canal. There wboth the foraminal area and the spinal canal area were enlarged. The intervertebral space height in the two groups recovered significantly after surgery, the difference was statistically significant. But the intervertebral space height were partly lost at the last follow-up, and there was significant difference compared with postoperative. During the follow-up, no pedicle screw loosening, displacement, rupture, or anterior and lateral displacement of cage occurred. The fusion rate was 97.1% in the posterior fusion group and 100% in the oblique lateral fusion group. There was no statistical difference between the two groups.In terms of ODI index: the posterior fusion group recovered from 48.6±6.1 preoperative to 10.2±2.2 at the last follow-up, and the oblique lateral fusion group recovered from 49.0±5.7 preoperative to 9.3±1.8 at the last follow-up. There was statistically difference between last follow-up and preoperative in the two groups. The incidence of complications in the posterior fusion group was 22.86%, and the incidence in the oblique lateral fusion group was 23.68%. There was no significant difference between the two groups. Conclusion:Both the two decompression and fusion methods have achieved good clinical results in the treatment of lumbar spinal stenosis, with the advantages of less trauma, good stability, fast recovery, and high fusion rate. Compared with posterior decompression and fusion methods, the advantages of OLIF are more obvious, such as less bleeding,lower risk of nerve injury and good indirect decompression of spinal canal. Therefore, the OLIF technique can be a better choice for surgical treatment of lumbar spinal stenosis.