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Objectives:To explore the accuracy of pedicle screw placement assisted with improved 3D-print-ed drill guiding template in cervical spine.Methods:The clinical data of 60 patients undergone posterior cervical pedicle screw placement in our hospital between January 2016 and January 2023 were analyzed retro-spectively,including 30 males and 30 females with an average age of 17-84 years(58.7±13.8 years).The pa-tients were divided into guiding template group and free-hand group based on whether the guiding template was used to assist the placement of screws or not.The improved 3D-printed guiding template was used to assist cervical pedicle screw placement in the guiding template group(n=30),and the self-made angular-ruler was used in the free-hand group(n=30).There was no significant difference in age,gender ratio,and preoper-ative diagnosis between the two groups(P＞0.05).Cervical CT scan was performed at one week after surgery,and the accuracy of pedicle screw placement was evaluated according to the Kaneyama standard:Grade 0,the screw was completely in the pedicle;Grade 1,the size of screw penetrating the cortex＜50%of the screw diameter;Grade 2,the size of screw penetrating the cortex≥50%of the screw diameter but not com pletely out;Grade 3,the screw was completely on the outside of the pedicle.The accuracy of pedicle screw placement(ratio of grades 0 and 1)and complications such as vascular and nerve injury,incision infection,cerebrospinal fluid leakage,screw loosening and breakage caused by screw misplacement were recorded.Re-sults:A total of 152 pedicle screws were placed in the guiding template group,including 74 screws of grade 0,68 of grade 1,10 of grade 2 and 0 of grade 3,with an accuracy of screw placement of 93.4%.A total of 136 pedicle screws were placed in free-hand group,including 53 screws of grade 0,61 of grade 1,18 of grade 2 and 4 of grade 3,with an accuracy of screw placement of 83.8%.The accuracy of screw placement in the guiding template group was significantly higher than that in the free-hand group(P＜0.05).There were no related complications such as vascular and nerve injury,incision infection and cerebrospinal fluid leakage caused by misplacement of pedicle screws.The patients were followed up for 5-29 months(14.2±7.7months),and there were no complications such as screw loosening or breakage.Conclusions:Improved 3D-printed drill guiding template can improve the accuracy of pedicle screw placement in cervical spine.
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Objectives:To explore the safety and accuracy of subaxial cervical pedicle screw(CPS)insertion assisted with optimized 3D-printed drill guiding template(DGT).Methods:A retrospective study was conducted to analyze the clinical data of 42 patients aged 32-74 years(50.1±9.8 years)who underwent posterior cervi-cal pedicle screw intemal fixation between August 2016 and October 2022.The patients were followed up for 13-25 months(19.6±3.2 months).They were divided into two groups of guiding template group(n=22)and free-hand group(n=20)according to the method of pedicle screw insertion.In the guiding template group,the sub-axial CPSs insertions were assisted with 3D-printed DGT,designed individually for each patient based on the design scheme of an optimized pedicle drill guiding template,and the patients consisted of 12 males and 10 females,among which 6 patients were with cervical spine injury or spinal cord injury,9 were with ossifica-tion of posterior longitudinal ligament(OPLL),5 were with intraspinal tumor,and 2 were with cervical spondy-lotic myelopathy.In the free-hand group,the subaxial CPSs were inserted with free hand according to the cervical parameters such as pedicle angle and diameter on the CT images measured before operation,and the patients consisted of 10 males and 10 females,among which 4 patients were with cervical spine injury or spinal cord injury,10 with OPLL,5 with intraspinal tumor,and 1 with cervical spondylotic myelopathy.There were no significant differences in sex,age,disease,and preoperative visual analogue scale(VAS)score and Japanese Orthopaedic Association(JO A)score between the two groups(P＞0.05).The operative time,intraopera-tive blood loss,and postoperative 12 months of VAS and JOA scores were recorded and compared.CT scan was performed at 1 week after operation on cervical spine,and the accuracy of pedicle screw placement was evaluated in accordance with Kaneyama's evaluation method:Grade 0,screw was contained in the pedicle;Grade 1,screw penetrated pedicle＜50％of the screw diameter;Grade 2,screw penetrated pedicle＞50％of the screw diameter;Grade 3,screw completely penetrated the pedicle.Grades 0 and 1 were considered accurate placement,and grades 2 and 3 were considered misplacement.The perioperative complications were recorded for each patient in the two groups.Results:The operative time,intra-operative blood loss in guiding template group(102.2±16.1min,89.3±17.7mL)were statistically less than those in free-hand group(142.8±20.9min,133.3±34.0mL)(P＜0.01).A total of 216 CPSs were placed:118 in the guiding template group,including 90 screws of grade 0,22 screws of grade 1,5 screws of grade 2,1 screw of grade 3,with an accuracy rate of 94.9％(112/118);And 98 in the free-hand group,including 48 screws of grade 0,36 screws of grade 1,10 screws of grade 2,and 4 screws of grade 3,with an accuracy rate of 85.7％(84/98).The accuracy rate of pedicle screw insertion was significant higher in the guiding template group than that in the free-hand group(P＜0.05).No major neurovascular complications nor internal fixation loosening or breakages were observed in two groups of patients.At 12 months after operation,the VAS score in both groups was statistically less than that before operation(P＜0.01),and the JOA score in both groups was statistically more than that before opera-tion(P＜0.01),and there were no significant differences in VAS score and JOA score between groups,respec-tively(P＞0.05).Conclusions:The optimized design scheme of 3D-printed DGT is helpful in improving the ac-curacy and safety of subaxial CPS insertion.
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@#The field of rehabilitation medicine physical therapist (PT) training and education has been relatively weak links in China, how to build a rehabilitation therapist team, we constantly explore and get a greater progress. However, most of the time is still confined to empty the contents of most theoretical level, and some basic steps and the specific contents are lacked. How to stabilize therapists team? How to position therapists? It deserves to pay more attentions.
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Objective To investigate the effect of cognition training on the recovery of balance after stroke. Methods forty-five hemiplegic strokd patents with cognition deficit were revruited and sddigned into an experimental group and a control group according to the results of an assessment with Loewenstein's Occupational Therapy Cognition Assessment battery (LOTCA). The patients in the two groups folloled routine systmatic rehabilitation programs. The patients in the (LOTCA). The patients in the two groups followed routine systmatic rehabilitation programs.The patiena in the experimental group received pertinent cognition training 5 days/week for 6 weeks. LOTCA,Brunel's Balance Assessment (BBA), the Berg Balance Scale (BBS) and Brunnatrom functional categories were enployed to evaluate the patients before and after treatment with regard to their cognition, balance control and motor function in their lower limbs. Results After treatment, there were statistically significant differences between preand post-treatment BBA and BBS scores in all groups. Average BBA, BBS and LOTCA scores in the experimental group were significantly higher than in the control group. The improvements in BBS, BBA and LOTCA scores in the experimental grou were significantly greater than in control group. Conclusion Cognition treatment can contribute significantly to improving balance and postural control among stroke survivors.
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Objective To investigate microRNA expression profiles of colonic cancer without lymph node metastasis and identify the specific microRNAs associated with carcinogenesis of colon.Methods Cancerous and para-cancerous tissues (5 cm from cancer tissues of the colon) confirmed without lymph node metastasis were collected from 3 patients. The microRNAs were extracted and isolated by mirVana RNA kit. Hybridizations were made by applying the microRNAs to Agilent microRNA microarray. Data analysis was done by software of Feacture Extraction. The discovered microRNAs were confirmed by real time PCR assay. Results Twelve out of 14 microRNAs associated with colonic cancer were up-regulated in colonic tissues. They were miR-106b, miR-135b,miR-18a,miR-18b,miR-196b, miR-19a, miR-224, miR-335, miR-424, miR-20a' , miR-301b and miR-374a. The rest two of miR-378 and miR 378* were down-regulated. Two up-regulated microRNAs (miR-18a and miR-135b) were detected in 3 pairs of cancerous and para-cancerous tissues. The expression level of miR-18a and miR-135b were accordant with the results of real time PCR.Conclusions microRNA.such as miR-106b,miR-135b.miR-18a.miR-18b,miR-196b,ect,were differentially expressed between cancerous and para-cancerous tissues.Many of these target genes are supposed to participate in the process of multiple tunmorgenesis.These microRNAs play an important role in the carcinogenesis of colon.
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Objective To study the expression and clinical significance of?-catenin and c-myc in gastric adenocarcinoma and corresponding para cancer gastric mueosa.Methods Two hundreds and ninety seven samples were collected from 102 cases of gastric adenocarcinoma,including 102 cancerous tissues and 195 para-cancerous tissues.Each sample was made into 282,156 and 156 dots tissue microarrays.Expressions of?-catenin and c-myc proteins were detected by immunohistochemical stain- ing.Results The expressions of?-catenin and c-mye were increased gradually in the process of gastric carcinogenesis.The rates of?-catenin and c myc expression were higher in carcinoma than that in intesti- nal metaplasia( P＜0.05,P＜0.001).The aberrant expression of?-catenin was closely related to the depth of invasion(P＜0.05),and the expression of c-myc was related to histological grade( P＜0.05). The aberrant expression of?-catenin was significantly correlated with the expression of c-myc in gastric adenocarcinoma(P＜0.05).Conclusions The aberrant expression of?-catenin may activate the expres sion of target gene c-myc,which plays a pivotal role in the carcinogenesis and progression of gastric adenocarcinoma.