Blood pressure variability and short-term outcomes after mechanical thrombectomy in patients with acute ischemic stroke.

OBJECTIVES: There is limited data evaluating effects of post-mechanical thrombectomy (MT) blood pressure (BP) control on short-term clinical outcomes in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). We aim to investigate the association of BP variations, after MT, with stroke early outcomes. MATERIALS AND METHODS: A retrospective study was conducted on AIS patients with LVO undergoing MT at a tertiary center over 3.5 years. Hourly BP data was recorded within the first 24- and 48-hours post-MT. BP variability was expressed as the interquartile range (IQR) of BP distribution. Short-term favorable outcome was defined as modified Rankin scale (mRS) 0-3, discharge to home or inpatient rehabilitation facility (IRF). RESULTS: Of the 95 enrolled subjects, 37(38.9%) had favorable outcomes at discharge and 8 (8.4%) died. After adjustment for confounders, an increase in IQR of systolic blood pressure (SBP) within the first 24 hours after MT revealed a significant inverse association with favorable outcomes (OR 0.43, 95% CI [0.19, 0.96], p = 0.039). Increased median MAP within the first 24 hours after MT correlated with favorable outcomes (OR 1.75, 95% CI [1.09, 2.83], p = 0.021). Subgroup analysis redemonstrated significant inverse association between increased SBP IQR and favorable outcomes (OR 0.48, 95% CI [0.21, 0.97], p = 0.042) among patients with successful revascularization. CONCLUSIONS: Post-MT high SBP variability was associated with worse short-term outcomes in AIS patients with LVO regardless of recanalization status. MAP values may be used as indicators for functional prognosis.

Identification of three new microsatellites and their effects on body measurement traits in pigs using time of flight-mass spectrometry (TOF-MS).

The body status of livestock affects their physiological function and productive performances. Microsatellites, one of the most used DNA markers, have been found to be associated with pig productive traits. However, their identifications and effects on body measurement traits of the Chinese Qinghai Bamei pig still uncovered. According to our previous sequencing data, in this study, three novel microsatellites were found in this breed. Using time of flight-mass spectrometry (TOF-MS) method, these microsatellites were further identified in a large Bamei pig population. TOF-MS spectra showed that there are three microsatellites loci, named P1, P2 and P3. These microsatellites were linkage equilibrium based on the values of D' and r2 tests. Association results demonstrated that P1 locus was associated with the body length, body height and chest width and the beneficial genotype was 150-/150-bp (p < 0.05); and P2 locus was associated with the body height (p < 0.05), and the 145-/145-bp, 145-/147-bp and 145-/149-bp were claimed as favorable genotypes and 145-bp allele was considered as the favorable allele. These findings suggested that P1 and P2 microsatellites might be considered as the candidate genetic markers to select pigs with superior body sizes, especially in local breed.

Development of ELISA and chemiluminescence enzyme immunoassay for quantification of histamine in drug products and food samples.

Histamine (HA) is a biogenic amine associated with allergies and food poisoning. It is an important indicator of food freshness and quality. In recent years, a series of medical negligence cases have been reported to be related to the intravenous injection of antibiotics produced via fermentation with fish peptone due to HA contamination. To detect HA efficiently, mouse monoclonal antibody was developed. An enzyme-linked immunosorbent assay (ELISA) and a chemiluminescence enzyme immunoassay (CLEIA) were developed and compared with conventional HPLC analysis. Both immunoassays showed low cross-reactivity, low 50% inhibitive concentration (IC50; 1.2 µg/mL and 1.1 µg/mL), low limits of detection (LODs, IC10; 89.0 ng/mL and 73.4 ng/mL), and appreciable recoveries in spiked foods and drugs (from 73.4 to 131.0% and from 77.0 to 119.0%, espectively), demonstrating that the developed methods are sensitive, specific, fast, and reliable for HA detection in complicated real samples. Graphical abstract.

Analysis of spinal stress analysis application in determining method for the pedicle screw placement under the guidance of X-Ray.

OBJECTIVE: To evaluate the accuracy of a novel guidance method of pedicle screw implantation determined by spinal stress. METHODS: We retrospectively analyzed patients underwent pedicle screw internal fixation between January 2015 and August 2018 in our hospital. Patients were divided into two groups according to the methods of pedicle screw implantation namely, the conventional nail placement and novel guidance method of pedicle screw implantation determined by spinal stress. Accuracy of spinal pedicle screw placements was evaluated using intraoperative and postoperative X-ray computed tomography (CT) examination and intraoperative touch of nerve root dissection pedicle bone. The success rate of intraoperative one-time screw placement was calculated according to Heary classification I. RESULTS: A total of 785 patients underwent pedicle screw internal fixation were retrospectively analyzed. Among them 384 patients were treated using conventional nail placement (Group A) and 401 patients were treated using the technique according to analysis of spinal stress (Group B). There was no significant difference in terms of the characteristics between two groups. There were significant differences in terms of the success rate of total of screw placement (88.7% vs. 96.2%, P < 0.001) including thoracic screw placement (87.8% vs. 94.5%, P = 0.003) and lumbar screw placement (88.8% vs. 96.5%, P = 0.001) for Group A and Group B, respectively. CONCLUSIONS: Using the novel guidance method of pedicle screw implantation determined by spinal stress might improve the accuracy of pedicle screw implantation.

Subunit mass analysis for monitoring multiple attributes of monoclonal antibodies.

RATIONALE: Multi-Attribute Methods (MAMs) are appealing due to their ability to provide data on multiple molecular attributes from a single assay. If fully realized, such tests could reduce the number of assays required to support a product control strategy while providing equivalent or greater product understanding relative to the conventional approach. In doing so, MAMs have the potential to decrease development and manufacturing costs by reducing the number of tests in a release panel. METHODS: In this work, we report a MAM which is based on subunit mass analysis. RESULTS: The MAM assay is shown to be suitable for use as a combined method for identity testing, glycan profiling, and protein ratio determination for co-formulated monoclonal antibody (mAb) drugs. This is achieved by taking advantage of the high mass accuracy and relative quantification capabilities of intact mass analysis using quadrupole time-of-flight mass spectrometry (Q-TOF MS). Protein identification is achieved by comparing the measured masses of light chain (LC) and heavy chain (HC) mAbs against their theoretical values. Specificity is based on instrument mass accuracy. Glycan profiling and relative protein ratios are determined by the relative peak intensities of the protein HC glycoforms and LC glycoforms, respectively. Results for these relative quantifications agree well with those obtained by the conventional hydrophilic interaction liquid chromatography (HILIC) and reversed-phase LC methods. CONCLUSIONS: The suitability of this MAM for use in a quality control setting is demonstrated through assessment specificity for mAb identity, and accuracy, precision, linearity and robustness for glycan profiling and ratio determination. Results from this study indicate that a MAM with subunit mass analysis has the potential to replace three conventional methods widely used for mAb release testing including identification assay, glycosylation profiling, and ratio determination for co-formulated mAbs.

Non-uniform Stiffness within Gastrocnemius-Achilles tendon Complex Observed after Static Stretching.

Higher stiffness of the Achilles tendon (AT) and gastrocnemius have been found to be risk factors associated with Achilles tendinitis. Static stretching (SS) is one intervention that has been investigated to improve the flexibility and therefore reduce injury risk. Previous studies have investigated the acute effect of SS on one region for AT and gastrocnemius morphology and stiffness; however, there is a lack of knowledge about the effect of SS on other regions of the AT and gastrocnemius (e.g., proximal vs. distal, within gastrocnemius). The aims of the present study were: (1) to investigate the acute effects of SS on the shear modulus of the medial gastrocnemius muscles (MG) and lateral gastrocnemius muscles (LG) and AT for different regions; (2) to examine the differences in range of motion (ROM) before and after SS; and (3) to investigate the change of thickness of AT and fascicle length of MG and LG before and after SS. The stiffness of AT and the gastrocnemius, fascicle length of the muscles, thickness of the AT, and maximal ankle joint dorsiflexion angle were measured in thirty healthy subjects (15 males, 15 females) before(pre) and immediately after (post) 5-minute SS. Stretching effects are not homogeneous among different regions. After SS administration, the proximal, middle, and distal regions of MG stiffness decreased by 34.12%, 22.45%, and 25.27%, respectively (p = 0.000), and LG stiffness decreased by 37.71%, 30.47%, and 22.13%, respectively (p = 0.000), whereas AT stiffness increased by 25.73%, 17.01%, and 19.53%, respectively (p= 0.000). ROM of ankle joint increased by 8.02% (p=0.00). Nevertheless, there were no changes in the thickness of AT and fascicle length of the gastrocnemius. These results suggest that non-uniform behaviour is consistently present within the gastrocnemius and AT, and the gastrocnemius heterogeneity is reduced after SS. The stretching maneuver could be effective to increase the flexibility.

Drug prescription patterns in osteoarthris patients in a tertiary care hospital in China.

The study was conducted to evaluate the prescription patterns of various agents for OA in a population specific cohort in Shandong Province, China. Data obtained from the Hospital Databases, which consisted of electronic medical records and prescription information. All the enrolled study subjects (n=212546) were having a clinically detected osteoarthritis (OA) during 2010-2015. Medicines prescription pattern was demonstrated using medication possession ratio (MPR), corresponding number of days administered with that particular medicine. The drugs examined comprised of analgesics (metamizole and paracetamol), oral and topical NSAIDs, cyclooxygenase 2 (COX-2) inhibitors, opioids (fentanyl and tramadol) and symptomatic slow-acting drugs in osteoarthris (SYSADOA). The most generally employed regimen for the treatment OA was consisted of mainly three agents (53.5% OA patients). Most regularly used medicines (MPR >50%) were chondroitin (21%), glucosamine (16%) and oral NSAIDs (14%). Use of chondroitin, COX-2 inhibitors and opioids was increased beyond five years of tenure. However, frequency of all the other drugs was decreased. The combination-regimens could cause potential drug interactions, may impact the health of OA patients. In this study, the increment in the use of COX-2 inhibitors and opioids is substantial due to the effect on safety and prices of the medication.

Applications of the scoliosis width-to-length ratio for guiding selection of the surgical approaches of degenerative lumbar scoliosis.

BACKGROUND: There does not exist a comprehensive parameter for guiding selection of short or long segment fusion for degenerative lumbar scoliosis (DLS). The aim of our study was to investigate the applications of the width-to-length ratio in guiding selection of the surgical approaches for DLS. METHODS: A retrospective analysis was performed of 142 patients with DLS who underwent operative treatments from July 2000 to January 2012. The scoliosis width-to-length ratios were measured and used as a grouping criterion of surgical approaches. The Oswestry disability index (ODI) was used to evaluate the clinical outcomes. Radiological parameters such as Cobb's angle of main curve, Cobb's angle of compensatory curve were all measured. RESULTS: For patients with width-to-length ratio less than 0.36, the short segment group had better short-term postoperative outcomes with regard to Cobb's angle of main curve, Cobb's angle of compensatory curve and ODI scores compared to the long segment group. However, for patients with width-to-length ratio greater than 0.36, the postoperative outcomes for the long segment group were better compared to the short segment group. CONCLUSIONS: The scoliosis width-to-length ratio can provide a comprehensive preoperative assessment of the severity of the DLS and guiding selection of a therapeutic treatment regimen. Further studies with a larger number of samples and longer term of follow up are warranted.

Association Between Single Nucleotide Polymorphisms in NFATC1 Signaling Pathway Genes and Susceptibility to Congenital Heart Disease in the Chinese Population.

The nuclear factor of activated T lymphocytes (NFATC1) signaling has been demonstrated to play important roles in cardiac valve and septal development. Genetic variants in genes involved in NFATC1 signaling may affect their expression and promote the formation of congenital heart disease (CHD). The goal of this study was to investigate the associations of single nucleotide polymorphism (SNP) in seven genes (NFATC1, VEGFR, VEGF, RANKL, FGFR1, BCL-6 and ZNRD1) with the risk of CHD. Twenty-nine polymorphisms were genotyped by using MassARRAY RS1000 platform in 277 CHD child patients and 293 controls from the Henan Province in China. Fours SNPs were excluded for the association analysis because of deviation from the Hardy-Weinberg equilibrium. Of the 25 SNPs, only two were found to be significantly associated with increased CHD risk after Bonferroni correction (RANKL, rs4531631: homozygous, AA vs. GG; OR 2.38, 95 % CI 1.40-4.07, p = 0.001; recessive, AA vs. AG + GG; OR 2.54, 95 % CI 1.53-4.22, p = 0.0003; FGFR1, rs13317: recessive, CC vs. CT + TT; OR 2.06, 95 % CI 1.30-3.25, p = 0.00196). Our findings suggest rs4531631 and rs13317 may be potential biomarkers for genetic diagnosis and treatment of CHD.

Association of DNMT1 Gene Polymorphisms with Congenital Heart Disease in Child Patients.

To reveal the association between DNMT1 polymorphisms and congenital heart disease (CHD) in child patients, a total of 224 CHD child patients as well as 199 healthy individuals were enrolled in the present study. The DNA was extracted from whole blood, and four SNPs including rs16999593, rs2228612, rs2288349 and rs10420321 were selected for the gene polymorphism investigation via ligase detection reaction (LDR) assay. Odds ratios (ORs) and 95 % confidence intervals (95 % CIs) were used to assess the strength of the association. rs16999593 was associated with the CHD under the heterozygous (CT vs TT: OR 0.62; 95 % CI 0.41-0.95; p = 0.03), dominant (CT + CC vs TT: OR 0.63; 95 % CI 0.42-0.95; p = 0.03), and allele models (C vs T: OR 0.07; 95 % CI 0.50-1.00; p = 0.05). rs2228612 was related with the CHD under the heterozygous (AG vs AA: OR 0.42; 95 % CI 0.27-0.65; p = 0.0001), homozygous (GG vs AA: OR 0.43; 95 % CI 0.240-0.77; p = 0.004), dominant (AG + GG vs AA: OR 0.42; 95 % CI 0.28-0.64; p < 0.0001), and allele models (G vs A: OR 0.62; 95 % CI 0.47-0.82; p = 0.0007). rs10420321 correlated with the CHD only under the recessive model (GG vs AG + AA: OR 0.61; 95 % CI 0.37-1.01, p = 0.05). However, no significant association between the rs2288349 polymorphisms and the risk of CHD was observed (p > 0.05). DNMT1 polymorphisms might contribute to the risk of CHD, especially rs16999593 and rs2228612.

Ketogenic diet therapy leads to antiseizure medication reduction in children and adults with drug-resistant epilepsy.

AIMS: This study aimed to evaluate the safety of reducing or withdrawing anti-seizure medications (ASMs) in a cohort comprising both adults and children with drug-resistant epilepsy (DRE) undergoing ketogenic diet therapy (KDT). METHODS: We conducted a comprehensive analysis of clinical profiles in adults and children with DRE who had adhered to KDT for at least 6 months. Successful withdrawal or reduction of an ASM was defined as discontinuation or dose reduction without subsequent resumption or increase and without initiation of any new ASM throughout the entire follow-up period. Changes in the ASM load were calculated specifically for adult patients. RESULTS: The study enrolled 56 participants (34 children and 22 adults) with DRE, with 64.3% achieving successful withdrawal of at least one ASM. The probability of ASM withdrawal remained consistent for children (64.7%) versus adults (63.6%), as well as for responders (62.5%) versus non-responders (68.8%), and it was not associated with other clinical factors. Early ASM reduction (including withdrawal) after diet initiation occurred in 15 patients (26.8%), with treatment outcomes comparable to those of the remaining participants. Among the 22 adults, the mean values of ASM load reduced by 24.5%, with a similar magnitude observed for responders (24.2%) versus non-responders (25.1%). In addition, adults tend to have a slower elevation in serum ketone levels compared to children. CONCLUSION: This study demonstrates the safe achievability of ASM withdrawal through KDT in most patients with DRE, irrespective of age or seizure frequency reduction.

Pharmacovigilance Study of Infigratinib: A Safety Analysis of the FDA Adverse Event Reporting System.

BACKGROUND: Infigratinib is a fibroblast growth factor receptor (FGFR)-specifc tyrosine kinase inhibitor indicated for the treatment of patients with previously treated, unresectable, locally advanced or metastatic cholangiocarcinoma. However, few studies have been conducted to evaluated the safety of infigratinib in the real world. In this study, we conducted a pharmacovigilance study to evaluate the adverse events (AEs) of infigratinib by using the Food and Drug Administration Adverse Event Reporting System (FAERS) database. METHODS: OpenVigil 2.1 was employed to extract the FAERS database. Descriptive analysis was used to describe the characteristics of infigratinib-associated AE reports. Disproportionality analysis was performed by calculating the proportional reporting ratio (PRR), reporting odds ratios (ROR), and Bayesian analysis confidence propagation neural network (BCPNN) to detect positive signals. RESULTS: Our findings revealed 149 AE reports, among which 36 significant signals were identified. These significant AE signals were mainly observed in gastrointestinal disorders (N = 26, ROR = 26.03, PRR = 8.44, information component [IC] = 3.08) and skin and subcutaneous tissue disorders (N = 21, ROR = 92.13, PRR = 40.41, IC = 5.34). Notably, dehydration and skin exfoliation were unexpected AEs, but had relatively high signal intensities (ROR = 29.75, PRR = 26.64, IC = 4.74; ROR = 50.61, PRR = 45.24, IC = 5.50, respectively) despite not being listed on the drug label. Furthermore, our analysis showed that infigratinib dose differed statistically between severe and non-severe reports (113.82 ± 16.13 mg vs 125 ± 0.00 mg, t = - 4.28; p < 0.001). However, there were no significant differences in sex, age, and types of AEs between the two groups (p  = 0.06, p  = 0.86, and p = 0.93, respectively). CONCLUSIONS: These findings suggest that gastrointestinal and skin toxicities are the most common adverse reactions for infigratinib. It is important to recognize skin exfoliation and dehydration in clinical practice, as they are unexpected AEs. Additionally, our study indicates that infigratinib dose may correlate with an increased risk of AE severity, highlighting the need for dose adjustment of infigratinib when exposure to the drug is increased due to internal or external factors.

Modified pedicle screw fixation under guidance of stress analysis for cervicothoracic junction: Surgical technique and outcomes.

BACKGROUND: In cervicothoracic junction, the use of strong fixation device such as pedicle screw placement is often needed. OBJECTIVE: The current study aimed to evaluate the accuracy and safety of pedicle screw placement using stress conduction analysis in the clinical application. METHODS: We retrospectively collected patients who underwent pedicle screw internal fixation in cervicothoracic junction. Patients were divided into conventional nail placement (Group A) and modified pedicle screw implantation under guidance of stress analysis (Group B) according to the methods of pedicle screw placement. The accuracy of pedicle screw placement was assessed by computed tomography (CT) examination, and the success rate was calculated. RESULTS: A total of 80 patients who underwent pedicle screw internal fixation in cervicothoracic junction were included. There were no obvious differences in baseline characteristics between two groups. The success rate of total screw placement, cervical spine screw placement and upper thoracic spine screw placement in Group B was higher than those in Group A (P< 0.001, P= 0.005, P= 0.008). Additionally, Heary Grade I in the Group B was higher than Group A (P= 0.001). CONCLUSION: Stress analysis-guided technique can increase the accuracy of pedicle screw placement. Importantly, it meets the requirements of internal fixation of the cervicothoracic junction.

Arabidopsis N-MYC DOWNREGULATED-LIKE1, a positive regulator of auxin transport in a G protein-mediated pathway.

Root architecture results from coordinated cell division and expansion in spatially distinct cells of the root and is established and maintained by gradients of auxin and nutrients such as sugars. Auxin is transported acropetally through the root within the central stele and then, upon reaching the root apex, auxin is transported basipetally through the outer cortical and epidermal cells. The two Gbetagamma dimers of the Arabidopsis thaliana heterotrimeric G protein complex are differentially localized to the central and cortical tissues of the Arabidopsis roots. A null mutation in either the single beta (AGB1) or the two gamma (AGG1 and AGG2) subunits confers phenotypes that disrupt the proper architecture of Arabidopsis roots and are consistent with altered auxin transport. Here, we describe an evolutionarily conserved interaction between AGB1/AGG dimers and a protein designated N-MYC DOWNREGULATED-LIKE1 (NDL1). The Arabidopsis genome encodes two homologs of NDL1 (NDL2 and NDL3), which also interact with AGB1/AGG1 and AGB1/AGG2 dimers. We show that NDL proteins act in a signaling pathway that modulates root auxin transport and auxin gradients in part by affecting the levels of at least two auxin transport facilitators. Reduction of NDL family gene expression and overexpression of NDL1 alter root architecture, auxin transport, and auxin maxima. AGB1, auxin, and sugars are required for NDL1 protein stability in regions of the root where auxin gradients are established; thus, the signaling mechanism contains feedback loops.

Prevalence of diabetes and predictions of its risks using anthropometric measures in southwest rural areas of China.

BACKGROUND: To examine the prevalence of diabetes and prediabetes in Songming county, Yunnan province, South-west China and examine influences of anthropometric indicators on diabetic risk. METHODS: This study was a population based cross-sectional study of 1031 subjects in Songming County aged 30 years and older. Age-standardization was performed by using the 2010 Songming population as the standard population. After an overnight fasting, participants underwent an oral glucose tolerance test (OGTT), and venous blood glucose levels were measured to identify diabetes and prediabetes. Physicians completed questionnaires and blood pressure measurements; trained nurses measured anthropometric variables. Age-adjusted logistic regression models were used to assess the association between anthropometric variables and diabetes. RESULTS: Total prevalences of diabetes and prediabetes were 10.0% and 11.6%, respectively. In women, prevalence of diabetes and prediabetes significantly increased with body mass index (BMI),waist hip ratio (WHR), and waist-to-height ratio (WHtR). But in men, prevalence of diabetes and prediabetes only significantly increased with WHR and WHtR. Compared to 1st WHR tertile in women, there was a nearly tenfold increase in the risk of diabetes with 3rd WHR tertile (OR 10.50, 95% CI 3.95-27.86). Men with 3rd BMI tertile had 4.8-fold risk of getting diabetes compared to men with 1st WHtR tertile (OR 4.79, 95% CI 1.88-12.26). Only WHtR had significantly higher receiver operating characteristic (ROC) area than BMI in total men (0.668 vs. 0.561, p < 0.05). And in total women, only WHR had significantly higher ROC area than BMI (0.723 vs. 0.628, p < 0.05). In the partial correlation analysis controlling for waist circumference, only WHR had significant correlation with fasting plasma glucose (r = 0.132, p = 0.002) and 2-h plasma glucose (r = 0.162, p = 0.000) in women, and WHtR had a much stronger association with both fasting plasma glucose (r = 0.305, P = 0.000) and 2 h plasma glucose (r = 0.303, P = 0.000) than WHR in men. CONCLUSION: High prevalence of diabetes and prediabetes were found in this underdeveloped region. About half of total subjects with diabetes were undiagnosed. The association of obesity indices and diabetic risk factors varied with gender. The strongest predictors of diabetes were WHR for the female subgroup and WHtR for the male subgroup.

Reliability of shear wave elastography for the assessment of gastrocnemius fascia elasticity in healthy individual.

The mechanical properties of the deep fascia, particularly their stiffness, strongly affect the development of muscle pathologies (such as compartment syndrome) and the action of the muscles. However, the mechanical characteristics of the deep muscular fascia are still not clearly understood. The present study focuses on examining the reliability of ultrasonic shear wave elastography (USWE) devices in quantifying the shear modulus of the gastrocnemius fascia in healthy individuals, particularly their ability to measure the shear modulus of the deep fascia of the gastrocnemius during ankle dorsiflexion. Twenty-one healthy males (age: 21.48 ± 1.17 years) participated in the study. Using USWE, the shear moduli of the medial gastrocnemius fascia (MGF) and lateral gastrocnemius fascia (LGF) were quantified at different angles during passive lengthening. The two operators took turns measuring each subject's MGF and LGF over a 1-h period, and operator B took an additional measurement 2 h later. For the intra-operator test, the same subjects were measured again at the same time of day 5 days later. Both the intrarater [intraclass correlation coefficient (ICC) = 0.846-0.965)] and interrater (ICC = 0.877-0.961) reliability values for measuring the shear moduli of the MGF and LGF were rated as excellent; the standard error of the mean (SEM) was 3.49 kPa, and the minimal detectable change (MDC) was 9.68 kPa. Regardless of the ankle angle, the shear moduli of the LGF were significantly greater than that of the MGF (p < 0.001). Significant increases in the shear moduli of both the MGF and the LGF were observed in the neutral position compared to the relaxed position. These results indicate that USWE is a reliable technique to assess the shear modulus of the gastrocnemius fascia and detect its dynamic changes during ankle dorsiflexion. USWE can be used for biomechanical studies and intervention experiments concerning the deep fascia.

[Application of spinal surgical robots in minimally invasive surgery for thoracolumbar fracture].

OBJECTIVE: To evaluate the safety and accuracy of Renaissance robot navigation system in minimally invasive surgery for thoracolumbar fracture. METHODS: The clinical data of patients with thoracolumbar fracture who underwent posterior minimally invasive pedicle screw internal fixation from July 2016 to July 2019 was retrospectively analyzed. And the patients were divided into robot group and artificial group. Robot navigation assisted screw placement was used in robot group, and traditional unarmed screw placement was used in artificial group. There were 20 patients in robot group, including 13 males and 7 females, aged from 23 to 69 years old with an average of(45.05±11.81)years old, one case was T11 fracture, 2 cases were T12, 10 cases were L1, 6 cases were L2 and 1 case was L3. There were 20 patients in artificial group, including 11 males and 9 females, aged from 26 to 65 years old with an average of(43.40±11.22)years old, 2 cases were T11 fractures, 7 cases were T12, 10 cases were L1, and 1 case was L3. The numbers of fluoroscopy, operation time and intraoperative blood loss were observed. The screw position was evaluated by Neo method. RESULTS: A total of 126 screws were implanted in robot group and 124 screws were implanted in artificial group. The operation time, fluoroscopy times, intraoperative blood loss were(115.75±14.26) min, (7.95±0.89) times and (132.50±29.36) ml in robot group and (129.50±10.50) min, (14.40±2.56) times and(182.50±23.14) ml in artificial group, respectively, there was significant difference between the groups(P<0.05). According to Neo classification method, there were 122 screws at grade 0, 4 screws at grade 1 in robot group, and there were 108 screws at grade 0, 9 screws at grade 1 and 7 screws at grade 2 in artificial group. The accuracy of the robot group was better than that of artificial group(P<0.05). CONCLUSION: Compared with free hand screw placement, Renaissance robot navigation system can effectively improve the accuracy of pedicle screw placement, reduce the number of fluoroscopy times and intraoperative blood loss, thereby improving the safety of operation.

[Comparison of vesselplasty and percutanous kyphoplasty in the treatment of Kümmell disease].

OBJECTIVE: To compare the efficacy between vesselplasty and percutanous kyphoplasty (PKP) in the treatment of Kümmell disease. METHODS: The clinical data of patients with Kümmell disease from July 2018 to December 2019 were retrospectively analyzed. According to the different therapeutic methods, the patients were divided into vesselplasty group and PKP group. There were 20 patients in vesselplasty group, including 2 males and 18 females, aged from 54 to 83 years with an average of (67.40±7.44)years, 1 case of T10 fracture, 3 cases of T12 fracture, 9 cases of L1 fractures, 5 cases of L2 fractures and 2 cases of L3 fractures. There were 20 patients in PKP group, including 3 males and 17 females, aged from 56 to 81 with an average of(67.20±7.01) years, 2 cases of T10 fracture, 1 case of T11 fracture, 6 cases of T12 fracture, 10 cases of L1 fracture and 1 case of L3 fracture. Visual analogue scale(VAS), Cobb angle, anterior vertebral height were recorded before operation, 1 day after operation and 1 year after operation. Oswestry Disability Index(ODI) was recorded before operation, 1 month after operation and 1 year after operation. And bone cement leakage rate was compared between two groups after operation. RESULTS: All the patient were followed up for more than 1 year. In vesselplasty group, VAS score was 1.20±0.41, ODI was(13.50±3.10)%, Cobb angle was(17.20±3.12)° and anterior vertebral height was(20.20±1.35) mm at 1 year after operation. In PKP group, VAS score was 1.15±0.40, ODI was (13.20±3.00)%, Cobb angle was (17.10±3.19)° and anterior vertebral height was (20.10±1.37) mm at 1 year after operation. These index was significantly better than pre-operation through intra-group comparison(P<0.05), and there was no statistically difference between the two groups(P>0.05). There were 20 cases (20 vertebrae) in vesselplasty group, of which 1 case had bone cement leakage at the upper endplate, with a leakage rate of 5%(1/20). In PKP group, there were 20 cases (20 vertebrae), 3 cases of upward endplate leakage(3/7), 1 case of downward endplate leakage(1/7), 1 case of leakage to the front of the vertebral body(1/7), 2 cases of leakage to the side of the vertebral body(2/7), with a leakage rate of 35% (7/20). The difference between two groups was statistically significant(P<0.05). CONCLUSION: Vesselplasty in the treatment of Kümmell disease can better reduce leakage rate of bone cement and reduce complications.

Elasticity of the Achilles Tendon in Individuals With and Without Plantar Fasciitis: A Shear Wave Elastography Study.

The elastic properties of the Achilles tendon (AT) are altered in local injury or other diseases and in response to changes in mechanical load. Recently, elastography has been used to evaluate variations in tendon elastic properties, mainly among healthy individuals or athletes. Therefore, this study evaluated the biomechanical changes in ATs in individuals with and without plantar fasciitis (PF). The purposes were as follows: (1) to evaluate the passive stiffness of three regions of the AT which defined as 0 (AT0 cm), 3 (AT3 cm), and 6 cm (AT6 cm) above the calcaneal tuberosity in participants with and without PF, (2) to investigate the interplay between the passive stiffness in patients with PF and pain, (3) to detect optimal cut-off points of stiffness of the AT in assessing individuals with chronic PF, and (4) to determine the correlation between the plantar fascia thickness (PFT) and pain. This cross-sectional study included 40 participants (mean age = 51 ± 13 years). When the ankle was in a relaxed position, patients with PF experienced increased passive stiffness in AT0 cm (p = 0.006) and AT3 cm (P = 0.003), but not in the neutral position. Significant correlations were observed between pain and stiffness of AT (AT0 cm r = 0.489, P = 0.029; AT3 cm r = 487, P = 0.030; AT6 cm r = 0.471, P = 0.036), but not in the PFT (P = 0.557). Optimal cut-off stiffness was AT (452 kPa) in the relaxed ankle position. The plantar fascia of patients with PF was significantly thicker than that of the controls (P < 0.001). Findings from the present study demonstrate that tendon stiffness is a good indicator of the clinical situation of patients with PF. Monitoring passive tendon stiffness may provide additional information to assess severity of the condition and guide therapeutic. The treatment programs for PF should also be tailored to the distal AT, as conventional therapy might not be targeted to tight tendons.