Percutaneous short segmental fixation combined with bone cement augmentation for stage III Kümmell's disease without nerve deformity.

The objective of this study was to evaluate the safety and efficacy of percutaneous pedicle screw fixation combined with bone cement augmentation in the management of stage III Kümmell disease without nerve deformity. A retrospective analysis was conducted on 17 patients diagnosed with stage III Kümmell disease without nerve deformity, who underwent treatment with percutaneous pedicle screw fixation combined with bone cement augmentation between April 2019 and 2022. Preoperative, postoperative, and final follow-up clinical outcome measures were collected, including Visual Analog Scale scores and Oswestry Disability Index scores. Additionally, lateral radiography was used to measure the Cobb angle and height of the anterior border of the affected vertebral body. Operative time, volume of injected bone cement, intraoperative cement leakage, and other complications were recorded. All patients underwent successful surgery, resulting in significant reductions in Visual Analog Scale scores, Oswestry Disability Index scores, and Cobb angle postoperatively; meanwhile there was a significant increase in height of the anterior border of the affected vertebral body. No major complications occurred during the follow-up period. In conclusion, percutaneous pedicle screw short-segment fixation combined with bone cement augmentation appears to be an effective surgical option for treating stage III Kümmell disease without nerve deformities.

[Clinical and radiologic comparison between oblique lateral interbody fusion and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis].

OBJECTIVE: To compare the short-term clinical efficacy and radiologic differences between oblique lateral interbody fusion(OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar spondylolisthesis. METHODS: A retrospective analysis was performed on 58 patients with lumbar spondylolisthesis treated with OLIF or MIS-TLIF from April 2019 to October 2020. Among them, 28 patients were treated with OLIF (OLIF group), including 15 males and 13 females aged 47 to 84 years old with an average age of (63.00±9.38) years. The other 30 patients were treated with MIS-TLIF(MIS-TLIF group), including 17 males and 13 females aged 43 to 78 years old with an average age of (61.13±11.10) years. General conditions, including operation time, intraoperative blood loss, postoperative drainage, complications, lying in bed, and hospitalization time were recorded in both groups. Radiological characteristics, including intervertebral disc height (DH), intervertebral foramen height (FH), and lumbar lordosis angle (LLA), were compared between two groups. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical effect. RESULTS: The operation time, intraoperative blood loss, postoperative drainage, lying in bed, and hospitalization time in OLIF group were significantly less than those in the MIS-TLIF group (P<0.05). The intervertebral disc height and intervertebral foramen height were significantly improved in both groups after the operation (P<0.05). The lumbar lordosis angle in OLIF group was significantly improved compared to before the operation(P<0.05), but there was no significant difference in the MIS-TLIF group before and after operation(P>0.05). Postoperative intervertebral disc height, intervertebral foramen height, and lumbar lordosis were better in the OLIF group than in the MIS-TLIF group (P<0.05). The VAS and ODI of the OLIF group were lower than those of the MIS-TLIF group within 1 week and 1 month after the operation (P<0.05), and there were no significant differences in VAS and ODI at 3 and 6 months after the operation between the two groups(P>0.05). In the OLIF group, 1 case had paresthesia of the left lower extremity with flexion-hip weakness and 1 case had a collapse of the endplate after the operation;in the MIS-TLIF group, 2 cases had radiation pain of lower extremities after decompression. CONCLUSION: Compared with MIS-TLIF, OLIF results in less operative trauma, faster recovery, and better imaging performance after lumbar spine surgery.

The analgesic efficacy of extracorporeal shock wave combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women.

BACKGROUND: To explore the analgesic efficacy of extracorporeal shock wave (ESW) combined with percutaneous vertebroplasty (PVP) after reduction in overextension position in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women. METHODS: The data of postmenopausal women with osteoporotic thoracolumbar compression fracture admitted in our department from January 2017 to October 2019 were analyzed retrospectively. They were divided into groups of unipedicular percutaneous kyphoplasty (U-PKP n = 21), bipedicular PKP (B-PKP n = 20), and ESW combined with PVP after reduction in overextension position (EP-PVP n = 18). The improvement of pain and vertebral height in three groups was compared. RESULTS: Postoperative compression rate and Cobb angle of vertebral fractures in the three groups were all lower than those before surgery, and the differences between pre-operation and post-operation were statistically significant (P < 0.05). The visual analog scale (VAS) and Oswestry dysfunction index (ODI) scores of the three groups decreased significantly after the operation (P < 0.05). The ODI scores of the EP-PVP group in the third months after the operation were significantly improved compared with the other two groups, and the difference was statistically significant (P < 0.05). CONCLUSIONS: In our small-sample study, all three treatment schemes can treat osteoporotic compression fracture of thoracolumbar vertebrae in postmenopausal women, relieve pain, and improve quality of life. ESW combined with PVP after reduction in overextension position could achieve a good vertebral reduction rate and improve kyphosis, and may reduce the application of analgesic drugs.

Structural basis of valmerins as dual inhibitors of GSK3ß/CDK5.

Development of multi-target drugs is becoming increasingly attractive in the repertoire of protein kinase inhibitors discovery. In this study, we carried out molecular docking, molecular dynamics simulations, molecular mechanics Poisson-Boltzmann surface area (MM-PBSA) binding free energy calculations, principal component analysis (PCA), and dynamical cross-correlation matrices (DCCM) to dissect the molecular mechanism for the valmerin-19 acting as a dual inhibitor for glycogen synthase kinase 3ß (GSK3ß) and cyclin-dependent kinase 5 (CDK5). Detailed MM-PBSA calculations revealed that the binding free energies of the valmerin-19 to GSK3ß/CDK5 were calculated to be -12.60 ± 2.28 kcal mol(-1) and -11.85 ± 2.54 kcal mol(-1), respectively, indicating that valmerin-19 has the potential to act as a dual inhibitor of GSK3ß/CDK5. The analyses of PCA and DCCM results unraveled that binding of the valmerin-19 reduced the conformational dynamics of GSK3ß/CDK5 and the valmerin-19 bound to GSK3ß/CDK5 might occur mostly through a conformational selection mechanism. This study may be helpful for the future design of novel and potent dual GSK3ß/CDK5 inhibitors.

[The study for the hemodynamics of expansive skin and the transplant time of skin flap designed by expansive skin].

OBJECTIVE: To study the change rule of the hemodynamics of expanded skins and research the transplant time of random-pattern flaps that are made of the expanded skin. METHODS: 72 ears of 64 rabbits were used as a subject of experiment. Four items of the contrasted skin (n = 8) and expanded skin (n = 8 x 8), Which include the microvessel diameter, the microvessel density, the blood velocity and the blood volume, were observed and measured by the microcirculatory imaging computer analysis system, the enzyme histochemical dyeing and the more functions colored pathological imaging computer analysis system. The length -width proportion and the largest area of the flaps that had made of the expansive skin and survived were measured. RESULTS: (1) The four items of expanded skin, that the microvessel diameter, the microvessel density, the blood velocity and the blood volume are 13.43 +/- 0.98 micrometer, 0.0472 +/- 0.0022, 1012.70 +/- 65.51 micrometer/s, 14.71 +/- 0.74 micrometer(3)/s respectively, are much bigger or quicker than those of contrasted skin [(7.22 +/- 0.71) micrometer, 0.0108 +/- 0.0002, (327.01 +/- 65.51) micrometer/s, (1.46 +/- 0.41) micrometer(3)/s] and there is the significant difference between both (6.49 < t < 49.49, P < 0.01). (2) The blood velocity increases in the expanding phases and always keeps on higher level. The other items all change periodically. Span of the period is four weeks. The microvessel diameter and the blood volume have a peak value at third weekend of every period and in the later period enhance more on the basis of the former period. The microvessel density changes in definite range in every period. (3) The surviving area of the random skin flaps is the largest which were made of the expanded skin in third weekend of every period, it changes more than those of other weekends in same period and later period is superior to the former period. There is a significant difference compared with contrasted random skin flaps (q = 3.7215, P < 0.05; q = 5.5026, P < 0.01). CONCLUSION: The hemodynamics of the expanded skin changes periodically in expansive course. The time of peak value of the blood volume is the best opportunity that random-pattern skin flaps are made of the expanded skin in every period.