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OBJECTIVE: To summarize the reasons and management strategies of reoperation after oblique lateral interbody fusion (OLIF), and put forward preventive measures. METHODS: From October 2015 to December 2019, 23 patients who underwent reoperation after OLIF in four spine surgery centers were retrospectively analyzed. There were 9 males and 14 females with an average age of (61.89±8.80) years old ranging from 44 to 81 years old. The index diagnosis was degenerative lumbar intervertebral dics diseases in 3 cases, discogenic low back pain in 1 case, degenerative lumbar spondylolisthesis in 6 cases, lumbar spinal stenosis in 9 cases and degenerative lumbar spinal kyphoscoliosis in 4 cases. Sixteen patients were primarily treated with Stand-alone OLIF procedures and 7 cases were primarily treated with OLIF combined with posterior pedicle screw fixation. There were 17 cases of single fusion segment, 2 of 2 fusion segments, 4 of 3 fusion segments. All the cases underwent reoperation within 3 months after the initial surgery. The strategies of reoperation included supplementary posterior pedicle screw instrumentation in 16 cases;posterior laminectomy, cage adjustment and neurolysis in 2 cases, arthroplasty and neurolysis under endoscope in 1 case, posterior laminectomy and neurolysis in 1 case, pedicle screw adjustment in 1 case, exploration and decompression under percutaneous endoscopic in 1 case, interbody fusion cage and pedicle screw revision in 1 case. Visual analogue scale (VAS) and Oswestry disability index (ODI) index were used to evaluate and compare the recovery of low back pain and lumbar function before reoperation and at the last follow-up. During the follow-up process, the phenomenon of fusion cage settlement or re-displacement, as well as the condition of intervertebral fusion, were observed. The changes in intervertebral space height before the first operation, after the first operation, before the second operation, 3 to 5 days after the second operation, 6 months after the second operation, and at the latest follow-up were measured and compared. RESULTS: There was no skin necrosis and infection. All patients were followed up from 12 to 48 months with an average of (28.1±7.3) months. Nerve root injury symptoms were relieved within 3 to 6 months. No cage transverse shifting and no dislodgement, loosening or breakage of the instrumentation was observed in any patient during the follow-up period. Though the intervertebral disc height was obviously increased at the first postoperative, there was a rapid loss in the early stage, and still partially lost after reoperation. The VAS for back pain recovered from (6.20±1.69) points preoperatively to (1.60±0.71) points postoperatively(P<0.05). The ODI recovered from (40.60±7.01)% preoperatively to (9.14±2.66)% postoperatively(P<0.05). CONCLUSION: There is a risk of reoperation due to failure after OLIF surgery. The reasons for reoperation include preoperative bone loss or osteoporosis the initial surgery was performed by Stand-alone, intraoperative endplate injury, significant subsidence of the fusion cage after surgery, postoperative fusion cage displacement, nerve damage, etc. As long as it is discovered in a timely manner and handled properly, further surgery after OLIF surgery can achieve better clinical results, but prevention still needs to be strengthened.
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Reoperação , Fusão Vertebral , Humanos , Feminino , Masculino , Fusão Vertebral/métodos , Pessoa de Meia-Idade , Idoso , Adulto , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Vértebras Lombares/cirurgia , Parafusos PedicularesRESUMO
Ziziphi Spinosae Semen (ZSS) is the first choice for the treatment of insomnia. This research aimed to reveal the spatial distribution of identifying quality markers of ZSS and to illustrate the metabolite quality characteristics of this herbal medicine. Here, we performed a matrix-assisted laser desorption/ionization-mass spectrometry imaging (MALDI-MSI) in situ to detect and image 33 metabolites in ZSS, including three saponins, six flavonoids, four alkaloids, eight fatty acids, and 12 amino acids. The MALDI images of the metabolites clearly showed the heterogeneous spatial distribution in different regions of ZSS tissues, such as the cotyledon, endosperm, and radicle. The distribution area of two saponins, six flavonoids, and three alkaloids increased significantly after the fried processing of ZSS. Based on the ion images, samples with different processing technologies were distinguished unambiguously by the pattern recognition method of orthogonal partial least squares discrimination analysis (OPLS-DA). Simultaneously, 23 major influencing components exerting higher ion intensities were identified as the potential quality markers of ZSS. Results obtained in the current research demonstrate that the processing of ZSS changes its content and distribution of the medicinal components. The analysis of MALDI-MSI provides a novel MS-based molecular imaging approach to investigate and monitor traditional medicinal plants.
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Flavonoides , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Ziziphus , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Ziziphus/química , Ziziphus/metabolismo , Flavonoides/análise , Flavonoides/metabolismo , Saponinas/análise , Saponinas/metabolismo , Alcaloides/análise , Alcaloides/metabolismo , Medicamentos de Ervas Chinesas/análise , Medicamentos de Ervas Chinesas/química , Medicamentos de Ervas Chinesas/metabolismoRESUMO
Malus toringoides (Rehd.) Hughes, called "Eseye (Ese)," is a traditional medicinal plant from the Tibet province of China that has proven effective in treating cardiac conditions due to its anti-inflammatory, antioxidative, and antiapoptotic properties. In this study, we explored the underlying protective mechanisms of Ese decoction in isoproterenol (ISO)-induced cardiac fibrosis (CF) and established the fact that treatment with an Ese decoction attenuated tissue injury, decreased the release of IL-1ß, IL-18, TNF-α, and caspase-3, and elevated the Bax/Bcl-2 ratio in CF mice. We also found that with Ese treatment damage to the mitochondrial ultrastructure of myocardium was alleviated, and the level of reactive oxygen species was markedly diminished. Ese inhibited the expression of proteins associated with pyroptosis by the HK1/NLRP3 signaling pathway and also improved CF. Due to the anti-inflammatory, antioxidative, and antiapoptotic characteristics of Ese decoction, we found that Ese protected against ISO-induced CF, by inhibiting inflammation and pyroptosis as mediated by the HK1/NLRP3 signaling pathway.
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Inflamação , Isoproterenol , Miócitos Cardíacos , Piroptose , Transdução de Sinais , Animais , Masculino , Camundongos , Fibrose , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Inflamação/induzido quimicamente , Camundongos Endogâmicos C57BL , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Extratos Vegetais/farmacologia , Extratos Vegetais/química , Piroptose/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/efeitos dos fármacosRESUMO
The efficient and accurate identification of diaphragm pump faults is crucial for ensuring smooth system operation and reducing energy consumption. The structure of diaphragm pumps is complex and using traditional fault diagnosis strategies to extract typical fault characteristics is difficult, facing the risk of model overfitting and high diagnostic costs. In response to the shortcomings of traditional methods, this study innovatively combines signal demodulation methods with residual networks (ResNet) to propose an efficient fault diagnosis strategy for diaphragm pumps. By using a demodulation method based on principal component analysis (PCA), the vibration signal demodulation spectrum of the fault condition is obtained, the typical fault characteristics of the diaphragm pump are accurately extracted, and the sample features are enhanced, reducing the cost of fault diagnosis. Afterward, the PCA-ResNet model is applied to the fault diagnosis of diaphragm pumps. A reasonable model structure and advanced residual block design can effectively reduce the risk of model overfitting and improve the accuracy of fault diagnosis. Compared with the visual geometry group (VGG) 16, VGG19, ResNet50, and autoencoder models, the proposed model has improved accuracy by 35.89%, 80.27%, 2.72%, and 6.12%. Simultaneously, it has higher operational efficiency and lower loss rate, solving the problem of diagnostic lag in practical engineering. Finally, a model optimization strategy is proposed through model evaluation metrics and testing. The reasonable parameter range of the model is obtained, providing a reference and guarantee for further optimization of the model.
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Cichoric acid (CA), a natural phenolic compound found in many plants, has been reported to have antioxidant, anti-inflammatory, hypoglycemic, and other effects. The aim of this study was to determine the potential role and underlying mechanisms of CA in isoproterenol (ISO)-induced myocardial fibrosis (MF). The MF model was induced by subcutaneous ISO injection in mice. Blood and heart tissue were collected for examination. Hematoxylin and eosin staining and Masson's trichrome staining were used to evaluate the histopathological changes and collagen deposition. The production of reactive oxygen species markers was observed by fluorescence microscopy, the degree of cardiomyocyte microstructure injury was observed by transmission electron microscope, and oxidative stress factors were detected by kit method, and the effect of CA on inflammatory factors was detected by ELISA. The expression levels of collagen proteins and signaling pathways were further investigated by western blotting. The results showed that CA inhibited the expression of ISO-induced proinflammatory factors (TNF-α, IL-1ß, and IL-18) and proteins (HK1, NLRP3, caspase-1, cleaved-caspase-1, and ASC), and regulated the expression of apoptotic factors (caspase-3, cleaved-caspase-3, Bax, and Bcl-2). The results indicated that CA may regulate the HK1/NLRP3 inflammasome pathway by inhibiting HK1 expression and play a protective role in MF.
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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 gradeâ , and 2 patients were gradeâ ¡). 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.
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Doenças Ósseas Metabólicas , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Dor Lombar , Osteoporose , Escoliose , Fusão Vertebral , Espondilolistese , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Espondilolistese/cirurgia , Estudos Retrospectivos , Dor Lombar/etiologia , Vértebras Lombares/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Osteoporose/etiologia , Resultado do TratamentoRESUMO
BACKGROUND The aim of this study was to investigate the safety and early clinical results of stand-alone oblique lateral interbody fusion (OLIF) in the fusion of lumbar spine lesions and to explore the indications for surgery. MATERIAL AND METHODS A total of 92 cases of lumbar spine lesions treated with stand-alone OLIF in 2 medical centers from October 2014 to December 2018 were retrospectively analyzed. We included 30 males and 62 females, ages 32-83 years. RESULTS Our results showed that the operation time was 60.92±27.40 min (average 36.6 min) and the intraoperative blood loss was 68.22±141.6 ml (average 23.8 ml). The height of the intervertebral space was restored - before the operation (9.23±1.94 mm) and (12.68±2.01 mm) after the operation - and it was 10.18±2.14 mm at the last follow-up. There was a significant difference between the postoperative and preoperative values (t=9.27, P<0.0001), and there was also a significant difference between the final follow-up and postoperative comparison value (t=8.43, P<0.0001). CONCLUSIONS The use of stand-alone OLIF in treating fusion of lumbar spine lesions showed excellent clinical efficacy and achieved the expected clinical improvements.
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Fusão Vertebral , Masculino , Feminino , Humanos , Estudos Retrospectivos , Fusão Vertebral/métodos , Vértebras Lombares/cirurgia , Resultado do Tratamento , Perda Sanguínea CirúrgicaRESUMO
The specific role of phlorizin (PHL), which has antioxidant, anti-inflammatory, hypoglycemic, antiarrhythmic and antiaging effects, on myocardial fibrosis (MF) and the related pharmacological mechanisms remain unknown. The objective of this study was to determine the protective actions of PHL on isoprenaline (ISO)-induced MF and its molecular mechanisms in mice. PHL was administered at 100 and 200 mg/kg for 15 consecutive days with a subcutaneous injection of ISO (10 mg/kg). MF was induced by ISO and alleviated by treatment with PHL, as shown by reduced fibrin accumulation in the myocardial interstitium and decreased levels of myocardial enzymes, such as creatinine kinase-MB, lactate dehydrogenase, and aspartate transaminase. In addition, PHL significantly decreased the expression of the fibrosis-related factors alpha smooth muscle actin, collagen I, and collagen III induced by ISO. The generation of intracellular reactive oxygen species induced by ISO was attenuated after PHL treatment. The malondialdehyde level was reduced, whereas the levels of superoxide dismutase, catalase, and glutathione were elevated with PHL administration. Moreover, compared to ISO, the level of Bcl-2 was increased and the level of Bax protein was decreased in the PHL groups. PHL relieved elevated TNF-α, IL-1ß, and IL-18 levels as well as cardiac mitochondrial damage resulting from ISO. Further studies showed that PHL downregulated the high expression of hexokinase 1 (HK1), NLRP3, ASC, Caspase-1, and GSDMD-N caused by ISO. In conclusion, our findings suggest that PHL protects against ISO-induced MF due to its antioxidant, anti-apoptotic, and anti-inflammatory activities and via inhibition of pyroptosis mediated by the HK1/NLRP3 signaling pathway in vivo.
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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.
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Escoliose , Fraturas da Coluna Vertebral , Fusão Vertebral , Espondilolistese , Humanos , Feminino , Masculino , Fraturas da Coluna Vertebral/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Vértebras Lombares/cirurgia , Espondilolistese/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodosRESUMO
Bombyx batryticatus is derived from the dried larva of Bombyx mori Linnaeus infected by Beauveria bassiana (Bals.) Vuillant. Raw Bombyx batryticatus should be stir-fried before oral administration due to its irritation to the gastrointestinal tract. Nevertheless, it is still an arduous task to uncover the intrinsic mechanism of Bombyx batryticatus processing. In this study, we collected two types of Bombyx batryticatus, one being stir-fried and the other serving as a control. Then, an informative approach, which integrated matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) with chemometrics analysis, was established to screen processing-associated markers and reveal in situ spatial distribution patterns of protein-related metabolites. After optimization of experimental conditions, 21 ions were initially detected from Bombyx batryticatus, including amino acids and peptides. In addition, 15 differential markers were screened by orthogonal projection to potential structure discriminant analysis (OPLS-DA), which were localized and visualized in the transverse section of Bombyx batryticatus by MSI. Eventually, it can be demonstrated that the stir-frying process reduces toxicity while potentially boosting specific biological activities of Bombyx batryticatus. In summary, the established strategy could not only clarify the chemical transformation of protein-related metabolites from Bombyx batryticatus before and after frying with wheat bran, but also reveal the significance of Chinese medicine processing technology.
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The special properties of fluorine atoms and fluorine-containing groups have led to an increasing number of applications for fluorine-containing organic compounds, which are also extremely widely used in the field of new drug development. Unfortunately, naturally fluorinated organics are rare in nature, so the selective introduction of fluorine atoms or fluorine-containing groups into organic molecules is very important for pharmaceutical/synthetic chemists. N-2,2,2-trifluoroethylisatin ketimines have received the attention of many chemists since they were first developed as fluorine-containing synthons in 2015. This paper reviews the organic synthesis reactions in which trifluoroethyl isatin ketimine has been involved in recent years, focusing on the types of reactions and the stereoselectivity of products, and also provides a prospect of its application in this field.
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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.
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Degeneração do Disco Intervertebral , Fusão Vertebral , Masculino , Feminino , Humanos , Pré-Escolar , Degeneração do Disco Intervertebral/cirurgia , Estudos Retrospectivos , Esclerose , Resultado do Tratamento , Vértebras Lombares/cirurgia , Fusão Vertebral/métodosRESUMO
OBJECTIVE: To summarize and compare the endplate injury occurrence characteristics and clinical results of transforaminal intervertebral fusion combined with pedicle screw fixation through intermuscular approach and oblique lateral intervertebral fusion combined with pedicle screw fixation in the treatment of lumbar disease. METHODS: A retrospective analysis of 213 cases of lumbar disease admitted from January 2016 to June 2019, including 73 males and 140 females. The age ranged from 24 to 81 years old, with an average of(54.9±10.5) years old. The courses of disease ranged from 6 to 180 months, with an average of (40.30±28.71) months. There were 35 cases of degenerative lumbar intervertebral disc disease, 22 cases of giant lumbar disc herniation, 15 cases of discogenic low back pain, 9 cases of primary lumbar intervertebral inflammation at the turn of inflammation, 52 cases of lumbar spinal stenosis, 47 cases of lumbar degenerative spondylolisthesis, 33 cases of lumbar spondylolysis with or without spondylolisthesis. There were 191 cases of single-segment lesions, including 5 cases on L2, 3, 24 cases on L3, 4, 162 cases on L4, 5. And there were 22 cases of two-segment lesions, including 3 cases on L2, 3 and L3, 4, and 19 cases on L3, 4 and L4, 5. One hundred and ten cases were taken by bilateral pedicle screw fixation and interbody fusion under the posterior muscle space approach (abbreviated as posterior fusion group), and 103 cases were taken by oblique lateral interbody fusion combined with bilateral pedicle screw fixation under the posterior muscle space approach (oblique lateral fusion group). Observed the characteristics of endplate injury in the two groups, and compared the clinical and imaging results and complications of the two groups. RESULTS: There were 8 cases of endplate injury occurred in 9 segments in the posterior fusion group. According to the number of cases, the incidence rate was 7.27%(8/110), 1 case was male, 7 cases were female, with an average age of (63.22±3.51) years old. Among the 8 cases, there were 7 cases of bone loss or osteoporosis before the operation, 5 cases using banana fusion cages, 3 cases using anatomical fusion cages. Three cases occurred in the upper endplate of the vertebral body and 6 cases in the inferior endplate of the vertebral body. In the oblique lateral fusion group, there were 21 cases of endplate injury in 24 segments, and the incidence rate was 20.39%(21/103). There were 4 males and 17 females, with an average age of (62.50±5.02) years old. Among the 21 cases, 16 cases were bone loss or osteoporosis before operation. There were 5 cases used large fusion cages, 4 cases had abnormal endplate anatomy, and 3 cases had iliac crest hypertrophy. It occurred in 20 segments of the upper endplate of the vertebral body, and 4 segments of the lower endplate of the vertebral body. Two of the 21 cases of endplate injury combined with vertebral body fractures. The incidence of endplate injury of the posterior fusion group was significantly lower than that of the oblique lateral fusion group. No incision infection occurred in the two groups, the follow-up time was ranged from 12 to 48 months, and the median follow-up period was 12 months. In the follow-up, 22 cases occurred fusion cage subsidence in the posterior fusion group, 43 cases in the oblique lateral fusion group, and 1 case in each group occurred fusion cage displacement. There was no loosening, displacement or breakage of the internal fixation. The incidence of complications in the oblique lateral fusion group 33.98%(35/103) was significantly higher than that in the posterior fusion group 23.64%(26/110), P=0.039. The height of the intervertebral space in both groups recovered well after the operation, but it was lost to varying degrees during follow-up. The fusion rate of the posterior fusion group was 94.5%(104/110), and 96.1%(99/103) in the oblique lateral fusion group(P=0.083). At the latest follow-up, the clinical symptoms of the two groups of patients were significantly improved. CONCLUSION: Two methods in treating single or two-segment lumbar spine lesions obtained good clinical effects. The characteristics of endplate injury in the two fusion methods are not completely the same. Although the endplate injury did not affect the final clinical results of the two fixed fusion methods, it still needs to be paid attention to and emphasize the prevention and effective treatment of endplate injury, especially for oblique lateral intervertebral fusion.
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Osteoporose , Fraturas da Coluna Vertebral , Fusão Vertebral , Espondilolistese , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Adulto , Idoso de 80 Anos ou mais , Espondilolistese/cirurgia , Fusão Vertebral/métodos , Estudos de Casos e Controles , Estudos Retrospectivos , Vértebras Lombares/cirurgia , Resultado do Tratamento , InflamaçãoRESUMO
With the development of industry and the rapid growth of population, the current water treatment technologies face many challenges. Hydrodynamic cavitation as a green and efficient means of water treatment has attracted much attention. During the hydrodynamic cavitation, enormous energy could be released into the surrounding liquid which causes thermal effects (local hotspots with 4600 K), mechanical effects (pressures of 1500 bar) and chemical effects (hydroxyl radicals). These conditions can degrade bacteria and organic substance in sewage. Moreover, the combination of hydrodynamic cavitation and other water treatment methods can produce a coupling effect. In this review, we summarize the methods of hydrodynamic cavitation and the performance of water treatment for different types of sewage. The application of hydrodynamic cavitation reactors with different structures in water treatment are also evaluated and discussed. The design and optimization of high-performance hydrodynamic cavitation reactor are the most crucial issues for the application of hydrodynamic cavitation in water treatment. Finally, recommendations are provided for the future progress of hydrodynamic cavitation for water treatment.
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Esgotos , Purificação da Água , Hidrodinâmica , Pressão , Purificação da Água/métodosRESUMO
Hydrodynamic cavitation was widely used in sterilization, emulsion preparation and other industrial fields. Cavitation intensity is the key performance index of hydrodynamic cavitation reactor. In this study, a novel rotor-radial groove (RRG) hydrodynamic cavitation reactor was proposed with good cavitation intensity and energy utilization. The cavitation performances of RRG hydrodynamic cavitation reactor was analyzed by utilizing computational fluid dynamics method. The cavitation intensity and the cavitation energy efficiency were used as evaluation indicators for RRG hydrodynamic cavitation reactor with different internal structures. The amount of generated cavitation for various shapes of the CGU, interaction distances and rotor speed were analyzed. The evolution cycle of cavitation morphology is periodicity (0.46 ms) in the CGU of RRG hydrodynamic cavitation reactor. The main cavitation regions of CGU were the outflow and inflow separation zones. The cavitation performance of rectangular-shaped CGU was better than the cylindrical-shaped CGU. In addition, the cavitation performance could be improved more effectively by increasing the rotor speed and decreasing the interaction distance. The research results could provide theoretical support for the research of cavitation mechanism of cavitation equipment.
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Hidrodinâmica , EsterilizaçãoRESUMO
ABSTRACT: Calcium (Ca) and magnesium (Mg), which play an important role in several cellular processes, is essential for normal development of the skeleton and maintenance of tissue homeostasis. Deficiency of these elements might delay bone fracture recovery or accelerates bone loss. We aimed to examine whether supplementation of trace element (TE) promotes fracture healing in accidentally fracturing adults by involvement of inflammatory mechanism.A short-term follow-up in clinic was performed. Totally, 117 subjects diagnosed with multiple fractures by traffic accidents were recruited in this study. Serum Ca and Mg levels were measured by inductively coupled plasma atomic emission spectrophotometry. Short-term changes such as serum C-reactive protein, interleukin (IL)-1ß, IL-6, and tumor necrosis factor alpha in normal treatment and TE supplement groups were detected by enzyme-linked immunosorbent assay. Student t test and the Spearman correlation were performed to analyze the data.Significantly negative correlations between Ca (râ=â0.7032; Pâ<â.001) and Mg (râ=â0.2719; Pâ<â.05) and injury severity score were observed. Serum Ca and Mg were significantly increased at Day 5, 7, and 9 following TE supplements. After treatment, serum C-reactive protein, IL-1ß, IL-6, and tumor necrosis factor alpha were significantly reduced whereas cytokine levels of the TE supplement group were found to be lower than that of the normal treatment group after Day 3.These findings suggest that Ca and Mg levels are associated with the injury severity of multiple fractures, and the supplement could reduce the inflammation, which may be beneficial for the bone recovery and disease process.
Assuntos
Cálcio/sangue , Citocinas/sangue , Fraturas Ósseas , Fraturas Múltiplas , Magnésio/sangue , Acidentes de Trânsito , Adulto , Proteína C-Reativa/análise , Cálcio/administração & dosagem , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Interleucina-6/sangue , Magnésio/administração & dosagem , Masculino , Pessoa de Meia-Idade , Espectrofotometria Atômica , Fator de Necrose Tumoral alfa/sangueRESUMO
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 L4,5 in 38 cases and L5S1 in 13 cases. All patients had a history of lower back pain and radiation pain of lower limbs(3 bilateral and 48 unilateral)and underwent unilateral pedicle screw combined with contralateral translaminar facet screw fixation and interbody fusion, among which 24 patients were treated through median incision approach (median incision group);other 27 patients were treated through muscle-splitting approach with channel-assisted exposure(muscle-splitting approach group). Operation time, intraoperative blood loss, postoperative drainage and incision length of the two groups were recorded. Visual analogue scale (VAS) was used to score the pain of lumbar incision at 72 h after operation, and JOA low back pain scoring system was used to evaluate the lumbar function preoperatively and at final follow-up. Imaging data were analyzed, including the changes in the height of intervertebral space of diseased segment before operation, 3 to 5 days after operation, and at final follow-up;Cobb angle changes in the coronal and sagittal planes of lumbar spine preoperatively and at final follow-up;multifidus area and multifidus fatty tissue deposition grade before and 12 months after operation; postoperative pedicle screw and laminar process screw position and intervertebral fusion condition. The complications of the two groups were compared. RESULTS: There was no statistical difference in operation time between two groups (P>0.05). Muscle-splitting approach group was better than median incision group in light of incision length, intraoperative blood loss and postoperative drainage volume (P<0.05). VAS score of lumbar incision pain at 72 h after operation was 1.61±0.54 in median incision group and 0.76±0.28 in muscle-splitting approach group(P<0.05). All patients were followed up for 12 to 84 (43.50±15.84) months. At final follow-up, the JOA scores of the two groups were significantly improved compared with those before operation(P<0.05). The rate of pedicle screw malposition was 6.25%(3/48) in medianincision group and 9.26%(5/54) in muscle-splitting approach group, there was no statistically significant difference between two groups (P>0.05). Rate of translaminar facet screw malposition in median incision group (12.50%) was significant less than the muscle-splitting approach group (18.52%)(P< 0.05). The height of the intervertebral space of the two groups was significantly restored 3 to 5 days after operation (P<0.05), and there was also a significant loss of height at final follow-up (P<0.05). At final follow-up, the balance of lumbar coronal plane and sagittal plane in two groups were improved very well (P<0.05). The comparison of the area and grade of the multifidus muscle in two groups 12 months after operation showed that obvious damage to the multifidus muscle were present in the median incision, while the multifidus muscle was less damaged by muscle-splitting approach (P<0.05). The fusion rate was 91.7%(22/24) in the median incision group and 92.6%(25/27) in muscle-splitting approach group(P>0.05). In median incision group, there were 1 case of intraoperative pedicle entry point fracture, 1 case of intraoperative dural tear and 1 case of postoperative nerve root injury;in muscle-splitting approach group, there were 1 case of intraoperative pedicle entry point fracture, 2 cases of intraoperative dural tear, 1 case of postoperative nerve root injury, 2 cases of incision epidermal necrosis and 1 case of poor incision healing. Nerve root injuries in the two groups were caused by incorrect positions of pedicle screws, the screws were immediately adjusted upon discovery. The nerve root symptoms were completely recovered 3 and 6 months after surgery. No incision infection was occurred in two groups. During the follow-up, no pedicle screw and laminar facet screw were loosened, displaced, broken, or intervertebral fusion cage moved forward and backward. The complication rate of 25.93% in muscle-splitting approach group was higher than 12.50% in the median incision group (P<0.05). 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.
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Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Parafusos Pediculares , Fusão Vertebral , Adulto , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Músculos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Hydrodynamic cavitation (HC) has emerged as one of the most potential technologies for industrial-scale water treatment. The advanced rotational hydrodynamic cavitation reactors (ARHCRs) that appeared recently have shown their high effectiveness and economical efficiency compared with conventional devices. For the interaction-type ARHCRs where cavitation is generated from the interaction between the cavitation generation units (CGUs) located on the rotor and the stator, their flow field, cavitation generation mechanism, and interaction process are still not well defined. The present study experimentally and numerically investigated the cavitation flow characteristics in a representative interaction-type ARHCR which has been proposed in the past. The cavitation generation mechanism and development process, which was categorized into "coinciding", "leaving", and "approaching" stages, were analyzed explicitly with experimental flow visualization and computational fluid dynamics (CFD) simulations. The changes in the cavitation pattern, area ratio, and sheet cavitation length showed high periodicity with a period of 0.5 ms/cycle at a rotational speed of 3,600 rpm in the flow visualization. The experimental and CFD results indicated that sheet cavitation can be generated on the downstream sides of both the moving and the static CGUs. The sheet cavitation was induced and continuously enlarged in the "leaving" and "approaching" stages and was crushed after the moving CGUs coincided with the static CGUs. In addition, vortex cavitation was formed in the vortex center of each CGU due to high-speed rotating fluid motion. The shape and size of the vortex cavitation were determined by the compression effect produced by the interaction. The findings of this work are important for the fundamental understanding, design, and application of the ARHCRs in water treatment.
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OBJECTIVE: To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures. METHODS: There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury. RESULTS: The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference(t=7.21, P=0.033). The ODI decreased from preoperative (36.5±7.7)% to (9.4±3.6)% at the latest follow-up, which was statistically difference (t=8.11, P=0.025). CONCLUSION: Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.
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Parafusos Pediculares , Fusão Vertebral , Lesões do Sistema Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controle , Lesões do Sistema Vascular/cirurgiaRESUMO
We herein report a highly efficient strategy for the stereoselective synthesis of structurally complex bispiro[oxindole-thiazolidinone-hexahydroxanthone]s. This squaramide-catalyzed domino Michael addition afforded these products in good to excellent yields with excellent stereoselectivities bearing five contiguous stereocenters with two spiroquaternary stereocenters. Meanwhile, both gram-scale synthesis and further transformation experiments have been also demonstrated.