Objective To observe the clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion. Methods A total of 41 patients with Hangman fracture were retrospectively analyzed, who underwent anterior cervical discectomy and fusion from May 2010 to May 2016. Intervertebral bone graft fusion was observed through postoperative radiographic images, and improvement of symptoms was evaluated by Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Modified Japanese Orthopaedic Association Scale (m-JOA). Surgical complications were evaluated as well. Results No severe complications occurred after surgery, but 5 patients had a transient dysphagia, which relieved spontaneously. Thirty-five patients had a fusion of intervertebral bone graft 3 months after surgery, and the remaining 6 patients did at the last follow-up. The VAS score was improved from 4.5±1.6 pre-operatively to 2.4±1.7 immediately post-operatively (P>0.05), and was further improved to 0.7±0.9 at the last follow-up (P<0.05). The NDI score was improved from 29.3±10.9 pre-operatively to 13.2±5.4 immediately post-operatively (P<0.05), and was further improved to 4.6±3.1 at the last follow-up (P<0.05). The m-JOA score was improved from 8.4±2.3 pre-operatively to 11.6±3.5 immediately post-operatively (P<0.05), and was further improved to 14.3±2.0 at the last follow-up (P<0.05). Conclusion Anterior cervical discectomy and fusion can be used in Hangman fracture, which is safe and reliable.
Objective To introduce the research of mesenchymal stemcells(MSCs) transplantation for treating intervertebral disc degeneration. Methods The recent original articles about the MSCs transplantation for treating intervertebral disc degeneration were extensively reviewed. Results Transplanted MSCs in intervertebral disc can express chrondcyte-like phenotype in certain conditions, increase matrix synthesis and release intervertebral disc degeneration. Conclusion MSCs transplantation for treating intervertebral disc degeneration may be a future approach.
Objective To introduce the latest advances of research on repair of the degenerative intervertebral disc with gene transduction.Methods The recentlypublished articles about the treatment of degenerative disc with gene transduction were reviewed, especially the articles published during the recent 5 years about the application of this therapy to regulating the synthesisand degradation of the extracellular matrix of the degenerative intervertebral disc.Results The shape and function of the normal intervertebral disc were reported to be closely related to the synthesis and degradation of the extracellular matrix of the intervertebral disc. The extracellular matrix of the intervertebral disc was a target for the gene transduction to repair the degenerative intervertebral disc. There was a great development of the treatment with gene transduction, especially in vector choice, target gene transduction, and transgene regulation and safety. Conclusion The advances of the research have indicated that repair of the degenerative intervertebral disc with gene transduction is a keyto curing the disease of the degenerative intervertebral disc.
Objective To introduce growth and differentiation factor 5 (GDF-5) gene into hBMSCs using recombinant adenovirus vector and to investigate the effect of GDF-5 gene expression on hBMSCs osteogenic differentiation. Methods Recombinant adenovirus GDF-5 (Ad-GDF-5) containing green fluorescent protein (GFP) and Ad-GFP were amplifiedand tittered. hBMSCs at passage 3 were infected with two viruses at different titers. At 2 days after intervention, GFP expression was observed using fluorescence microscope, and GDF-5 expression in hBMSCs was detected by RT-PCR. Adherent hBMSCs at passage 3 were randomly divided into 4 groups: experimental group (GDF-5 gene transfection), osteogenic induction group, Ad- GFP infection group, and control group. Cell differentiation was detected by inverted phase contrast microscope observation, fluorescence microscope observation, reverse transcription fluorescence quantitative PCR, immunofluorescence staining, and von Kossa staining at different time points after intervention. Results The titer of Ad-GDF-5 and Ad-GFP was 1.0 × 109 pfu/mL and 1.2 × 109 pfu/mL, respectively. hBMSCs was efficiently infected by Ad-GDF-5 and Ad-GFP, and expressed target gene and GFP gene. At 1-7 days after intervention, morphology and growth pattern of the hBMSCs in the experimental group and the osteogenic induction group were transformed into osteoblast-l ike cells, whereas the cells in the other two groups were still maintained their original morphology and growth pattern. Reverse transcription fluorescence quantitative PCR detection: at 4 days after intervention, GDF-5 expression in the experimental group was obviously higher than that of other groups (P lt; 0.05); ALP, Col I, and OC gene expression in the experimental and the osteogenic induction group were superior to those of theAd-GFP infection and the control group (P lt; 0.05); Col I gene expression in the osteogenic induction group was greater than that of the experimental group (P lt; 0.05). Immunofluorescence staining: at 4 days after intervention, the cells in the osteogenic induction group and the experimental group expressed and secreted Col I, and no expression of Col I was evident in the other two groups. At 10 days after intervention, the cells in the osteogenic induction and the experimental group were positive for von Kossa staining, and the results of the other two groups were negative. Conclusion GDF-5 gene can be transferred into hBMSCs via adenovirus vector and be expressed stably. It can facil itate the osteogenic differentiation of the hBMSCs and lay a foundation for the further study of this kind of gene transferred hBMSCs effect on bone tissue repair.
Objective To compare the sequential efficacy of high-flow nasal cannula oxygen therapy (HFNC) with non-invasive mechanical ventilation (NIV). Methods Randomized controlled trials comparing the efficacy of NIV sequential invasive mechanical ventilation with HFNC were included in the Chinese Journal Full-text Database, VIP Journal database, Wanfang Database, Chinese Biomedical Literature Database, PubMed, Cochrane Library and Embase. Meta-analysis was performed using RevMan5.4 software. Results A total of 2404 subjects were included in 19 studies. Meta-analysis results showed that compared with NIV, HFNC had a statistically significant difference in reducing patients' re-intubation rate in invasive mechanical ventilation sequence [relative risk (RR)=0.65, 95% confidence interval (CI) 0.50 - 0.86, Z=3.10, P=0.002]. HFNC showed statistically significant difference compared with NIV in reducing lung infection rate (RR=0.40, 95%CI 0.21 - 0.79, Z=2.67, P=0.008). HFNC was significantly different from NIV in terms of length of stay in Intensive Care Unit (ICU) (MD=–5.77, 95%CI –7.64 - –3.90, Z=6.05, P<0.00001). HFNC was significantly different from NIV in improving 24 h oxygenation index (MD=13.16, 95%CI 8.77 - 17.55, Z=5.87, P<0.00001). There was no significant difference in ICU mortality between HFNC and NIV (RR=0.70, 95%CI 0.45 - 1.08, Z=1.61, P=0.11). Conclusion Compared with NIV, sequential application of HFNC in invasive mechanical ventilation can improve the reintubation rate and pulmonary infection rate to a certain extent, reduce the length of ICU stay and improve the 24 h oxygenation index, while there is no difference in ICU mortality, which is worthy of clinical application.
Abstract： Objective To estimate the effectiveness and safety of intra-aortic balloon pump （IABP）in the patients with mild or mild to moderate aortic regurgitation. Methods A total of 15 patients with mild or mild to moderate aortic regurgitation and low left ventricular ejection fraction (LVEF＜ 40.00%) including 11 males and 4 females, who underwent IABP application after cardiac surgery between September 2006 and January 2011, were included in this study. Their age ranged from 50 to 74 years with an average age of 63.60 years. There were 9 patients with mild aortic regurgitation and 6 patients with mild to moderate aortic regurgitation, all with LVEF ＜ 40.00%. IABP catheters were inserted before operation and IABP worked after heart the recovery of heart beat. Mean aortic pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), LVEF , and aortic regurgitation volume before the use of IABP and after stopping use of it were compared. Results The total mortality was zero. The patients’ CI significantly improved from 1.99±0.23 L/(min.m2) to 3.30±0.29 L/(min.m2) after IABP （t =48.30，P=0.00）. Their LVEFs were significantly improved after use of IABP (37.20%±1.37% versus 42.60%±2.87%， t =11.34，P=0.00）. Their SVRI improved significantly (2 347.00±190.00 dyn·s/(cm5·m2) versus 2 128.00±204.00 dyn·s/(cm5 · m2)，t=20.60, P=0.00）after use of IABP. However, their aortic regurgitation volume were not significantly increased（χ2=0.60, P=0.44）. Conclusion Application of IABP in patients with mild or mild to moderate aortic regurgitation and low LVEF can obtain good circulation support after operation without increasing their aortic regurgitation.
In order to investigate the possible involvement of the antigen CA50 in patients with colorectal carcinoma， the carbohydrated antigen CA50 in serum was examined in 30 normal individual， 27 patients with benign colorectal diseases and 66 patients with colorectal carcinoma by immunoradiometric assay (IRMA). The results showed that the serum CA50 in patients with colorectal carcinoma was significantly higher than that in patients with benign colorectal diseases and normal individual (Ｐ＜0.01). It was significantly declined after radical operation (Ｐ＜0.01). However， no significant change was noted after palliative operation (Ｐ＞0.05) and elevation was noted in patients with tumor recurrence. The results suggest that the measurement of serum CA50 may be an useful marker for diagnosis and prognostic evaluation in patients with colorectal carcinoma.
Objective To evaluate the effectiveness, safety, cost and optimal dosing regimen of bone morphogenetic protein (BMP) used in the lumbar spine arthrodesis. Methods We formulated the clinical questions according to the PICO principle. We searched the ACP Journal Club (1991 to February 2008), The Cochrane Library (Issue 4, 2007) and PubMed (1990 to February 2008) as well as other relevant databases. The evidence retrieved was critically appraised. Results Current evidence showed that BMP was a satisfactory and safe behavior in lumbar arthrodesis. Its cost was equal to that of autogenous iliac bone graft. The types of BMP currently used in clinical practice are BMP-2 and BMP-7. Finished product of fixed composition ratio was recommended in anterior lumbar inter-body fusion, while in posterolateral fusion, 20mg of BMP-2 or 3.5mg of BMP-7 for each side was recommended, with proper carrier according to the place where it was used. Conclusion BMP may be introduced to China for lumbar spine arthrodesis. Before it is applied extensively, further large-scale, high-quality randomized controlled trials are needed. Meanwhile, more research is necessary to determine the proper dosage and preparation form for the dominant Chinese population.