[The efficacy analysis of neurosurgical robot-assisted DBS in the treatment of elderly Parkinson's disease]

Objective: To investigate the surgical efficacy of neurosurgery robot deep brain stimulation(DBS) in the treatment of elderly Parkinson's disease(PD). Methods: The clinical data of elderly patients (≥75 years) with PD who underwent neurosurgical robot-assisted DBS surgery in the Department of Neurosurgery of the General Hospital of Northern Theater Command from September 2016 to September 2022 were collected retrospectively. Operation time, electrode implantation duration, postoperative pneumocephalus volume, electrode implantation accuracy, the Tao's DBS surgery scale, perioperative complications were analyzed.The unified Parkinson's disease rating scales (UPDRS), UPDRS-Ⅲ, tremor, rigidity, bradykinesia, axial, Barthel Activities of Daily Living (ADL-Barthel), Levodopa Equivalent Daily Dose (LEDD), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores and mortality were assessed respectively before operation, 6, 12 and 24 months after operation and last follow-up. Results: A total of 25 elderly patients were enrolled, including 14 males and 11 females, aged(78.3±3.2) years. Nine patients had underlying diseases. Nine patients (36%) underwent bilateral Globus Pallidus pars Interna deep brain stimulation (GPi-DBS) and 16 patients (64%) underwent bilateral subthalamic nucleus deep brain stimulation (STN-DBS).The operation time was (1.56±0.19) hours, the electrode implantation duration was (1.01±0.19) hours, the pneumocephalus volume was 9.8(4.7, 23.3) cm3, and the electrode implantation accuracy was (0.84±0.24) mm, the Tao's DBS surgery scale was (80.2±6.2).The follow-up time [M(Q1, Q3)] was 57.3(27.9, 75.7) months. No serious complications such as intracranial hemorrhage, infection or poor wound healing occurred during the perioperative period. The improvement rate of UPDRS, UPDRS-Ⅲ, rigidity, bradykinesia, and LEDD at 6 months after surgery was significantly higher than that at 24 months after surgery and at the last follow-up (all P<0.05); the improvement rate of axial symptoms, ADL-Barthel score, and MoCA score at 6 months after surgery was significantly higher than that at the last follow-up (P<0.05). HAMD and HAMA scores showed no significant improvement during follow-up after surgery (both P>0.05). At the last follow-up, 12 patients died, with death time of (35.1±20.2) months after operation, and the death age of [M(Q1, Q3)] 80(79, 83)years. Conclusions: Robot-assisted DBS surgery for elderly patients with PD is accurate and safe, and the postoperative symptoms are significantly improved, and they can benefit from neuromodulation for long term, and the risks are controllable.

Micro-223 Promotes Diabetic Osteoarthritis Progression by Regulating Cartilage Degeneration and Subchondral Bone Remodeling

OBJECTIVE

Our study was performed to investigate whether micro-223 promotes diabetic Osteoarthritis (OA) progression by regulating cartilage degeneration and subchondral bone remodeling.

METHODS

The expression of miR-223 in human normal cartilage, OA cartilage, and subchondral bone tissue with or without DM was detected by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). miR-223 mimic or inhibitor was transfected into chondrocytes. Cell viability and apoptosis were assessed by 3-(4,5)-dimethylthiahiazo(-2)-3,5-diphenyltetrazolium bromide (MTT) and Terminal Deoxynucleotidyl Transferase(TdT)-mediated dUTP nick end labeling (TUNEL) assay, respectively.

RESULTS

miR-223 was significantly higher in human diabetic OA cartilage and subchondral bone compared with normal OA and healthy control. Overexpression of miR-223 accelerated cartilage degeneration and subchondral bone sclerosis in diabetic OA mice, whereas miR-223 inhibition had the opposite effect. In vitro upregulation of miR-223 decreased proliferation and enhanced apoptosis of chondrocytes. Meanwhile, downregulation of miR-223 promoted glycosaminoglycan (GAG) production in chondrocytes.

CONCLUSION

miR-223 promotes diabetic OA progression by regulating cartilage degeneration and subchondral bone remodeling both in vitro and in vivo.

[A study on the arthroscopic temporomandibular joint disc reduction on the outcome of orthodontic patients with anterior disc displacement without reduction]

Objective: To investigate the arthroscopic temporomandibular joint disc reduction on the outcome of orthodontic patients with anterior disc displacement without reduction. Methods: From January 2012 to December 2021, forty treated orthodontic patients with anterior disc displacement without reduction (unilateral/bilateral) and no obvious articular cartilage absorption were selected from Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The patients were (17.5±3.8) years old (12-25 years old), including 8 males and 32 females. Twenty patients who had completed arthroscopic temporomandibular joint disc reduction were included in the control group, and twenty patients with untreated temporomandibular joint disc were included in the experimental group. Model measurement (including overjet, etc.), cephalometric analysis (including ANB angle, which was formed by subspinale, nasion and supramental, etc.) and temporomandibular joint magnetic resonance imaging (including measurement of the condyle height of the displacement sides) were used to compare the difference of two groups. Objective grading system was used to evaluate the efficacy of orthodontic treatment. Results: The overjet of the experimental group and the control group after orthodontic treatment was (2.19±0.76) and (1.92±0.94) mm, respectively. Both two groups achieved ideal overjet with no statistical difference (t=1.02, P=0.314). The ANB angle difference before and after treatment in the control group (-1.97°±2.87°) was greater than that in the experimental group (0.09°±1.82°), and the difference was statistically significant (t=2.72, P=0.010). The variation of condyle height before and after treatment was (0.30±1.11) mm in the experimental group and (0.82±1.25) mm in the control group, with no statistical significance (t=1.80, P=0.076). The post-treatment objective grading system scores of the experimental group and the control group were 21.00 (16.00, 24.00) and 21.00 (17.00, 25.00), respectively, which had no statistical difference (U=0.24, P=0.808). Conclusions: In orthodontic patients with anterior disc displacement without reduction and no obvious articular cartilage absorption, whether displaced discs are repositioned after arthroscopic surgery has no significant effect on the orthodontic treatment outcome.

[Characteristics of PD-L1 expression in tumor cells and tumor microenvironment of DLBCL with MYD88 L265P mutation]

Objective: To study the effect of MYD88 L265P mutation on the expression of PD-L1 in tumor cells and tumor microenvironment in diffuse large B-cell lymphoma (DLBCL), and to provide theoretical basis for immunotherapy for patients. Methods: Multiplex ligation-dependent probe amplification (MLPA) was used to detect the frequency of MYD88 L265P mutation in 72 cases of DLBCL diagnosed by pathologists in Cancer Hospital of Chinese Academy of Medical Sciences from August 2008 to May 2010. Expression of PD-L1 in tumor cells and tumor microenvironment in all samples was evaluated using PD-L1 (22C3) and PD-L1 (SP142) with Ventana automatic immunohistochemical (IHC) platform. The relationship between MYD88 L265P mutation and the expression of PD-L1 in DLBCL tumor cells and tumor microenvironment was assessed. Results: Of the 72 cases of DLBCL, MYD88 L265P mutation was detected in 15 (20.8%) cases. Nine cases with JAK2 amplification were excluded, and the remaining 63 cases of DLBCL were divided into MYD88 L265P mutant group (n=14) and MYD88 L265P wild-type group (n=49). IHC results showed that among the 14 cases of MYD88 L265P mutant groups, PD-L1 (22C3) was positive in 7 cases (7/14) of tumor cells and PD-L1 (SP142) was positive in 4 cases (4/14) of tumor microenvironment. Among the 49 cases of MYD88 L265P wild-type group, 9 cases (18.4%) were positive for PD-L1 (22C3) in tumor cells, and 38 cases (77.6%) were positive for PD-L1(SP142) in tumor microenvironment. In addition, among the 16 cases with PD-L1(22C3) expression in tumor cells, only 2 of the 7 cases with MYD88 L265P mutation were positive for PD-L1 (SP142) in tumor microenvironment. All 9 cases with wild-type MYD88 L265P were positive for PD-L1 (SP142) in tumor microenvironment. Statistical analysis showed that the expression level of PD-L1 (22C3) in tumor cells in the MYD88 L265P mutant group was significantly higher than that in the MYD88 L265P wild-type group (P=0.017). The expression level of PD-L1 (SP142) in tumor microenvironment in the MYD88 L265P mutant group was significantly lower than that in the MYD88 L265P wild-type group (P=0.001). Conclusions: MYD88 L265P mutation may play an important role in the regulation of PD-L1 expression in DLBCL tumor cells and tumor microenvironment. Further studies will provide a theoretical basis for immunotherapy of DLBCL patients with MYD88 L265P mutation.

[Interaction of notch signaling pathway with toll-like receptor 4 on the function of CD14+ monocytes in chronic hepatitis C patients]

Objective: To observe the expressional changes in Notch signaling pathway and toll-like receptor 4 (TLR4) and their interactions on the functions of CD14(+) monocytes in chronic hepatitis C patients. Methods: A total of 24 treatment-naïve chronic hepatitis C cases and 10 healthy individuals, who visited Shaanxi Provincial People's Hospital from August to October 2017, were enrolled. Selected CD14(+) monocytes were stimulated by the Notch signaling pathway inhibitor DAPT or transfected with TLR4 siRNA, and the levels of Notch1, Notch2, Hes1 and Hes5 mRNA were detected by real-time quantitative PCR. TLR4 protein levels and phosphorylation of NF-κB was detected by Western blot. ELISA was used to detect the level of cytokines secreted from CD14(+) monocytes. A t-test or paired t-test was used for comparison between groups. Results: The relative expression of Notch1 mRNA (3.97 ± 2.03 vs. 0.91 ± 0.76, P < 0.01) and downstream of Notch signaling pathway (5.96 ± 2.31 vs. 0.99 ± 0.45, P < 0.01), Hes1 mRNA and Hes5 mRNA (4.31 ± 1.05 vs. 0.84 ± 0.20, P < 0.01) in CD14+ monocytes of chronic hepatitis C patients was significantly higher than that of healthy individuals. The relative expression of TLR4 mRNA (5.14 ± 1.09 vs. 1.27 ± 0.39) and protein level in CD14(+) monocytes of chronic hepatitis C patients were significantly higher than those of healthy individuals (P < 0.01). An inhibition of Notch signaling pathway with DAPT had reduced the relative expression level of TLR4 mRNA (2.58 ± 1.36 vs. 4.34 ± 1.88, P < 0.05), protein expression and phosphorylation of NF-B in CD14(+) monocytes of chronic hepatitis C patients. Furthermore, the secretion level of MCP-1 [(94.32 ± 23.59) pg/ml vs. (64.07 ± 9.39) pg/ml, P < 0.01] and IL-8 [(12.54 ± 4.89) pg/ml vs. (7.92 ± 3.01) pg/ml, P < 0.05] was significantly reduced. TLR4 siRNA transfection reduced the expressions of Notch1 mRNA (2.09 ± 1.72 vs. 3.73 ± 1.75, P < 0.05), Hes1 (2.87 ± 0.84 vs. 5.54 ± 0.97, P < 0.01), and Hes5 (2.89 ± 0.93 vs. 4.51 ± 1.54, P < 0.01) in CD14(+) monocytes of chronic hepatitis C patients. Conclusion: Interaction of Notch signaling pathway with TLR4 can promote the function of CD14(+) monocytes in chronic hepatitis C patients.

[MRI analysis of the effect on mandibular retrusion with anterior disc displacement treated by using Herbst appliance]

Objective: To investgate the effect of Herbst appliance on the growth and remodeling of the temporomandibular joint (TMJ) in class Ⅱ patients with mandibular retrusion by using MRI. Methods: Between December 2010 and October 2014, 12 class Ⅱ patients (11-16 years old) with mandibular retrusion were chosen. The patients were divided into two groups. The control group included 7 patients (14 joints) with normal disc condyle relationship and the anterior disc displacement (ADD) group included 5 patients (10 joints) with anterior disc displacement. The MRI images of TMJ were measured, including condylar height, joint space index and disc position ratio, before and after the treatment. Results: The condylar height of the patients in the control group was significantly increased (P<0.001) after treatment, and no significant difference in joint space index (P=0.821) and disc position ratio (P=0.146) was found. The joint space index of the patients ([-14.70±8.82]% and [4.90±11.35]%) in ADD group changed significantly (P<0.001) after treatment, and no significant difference in condylar height (P=0.294) and disc position ratio (P=0.120) was found. Conclusions: The normal disc condyle relationship was beneficial to the reconstruction of the condylar process, and the increase of the condylar height. The condyle moved forward in patients with anterior disc displacement after treatment.

Clinical value of ultrasound-guided percutaneous biopsy of pulmonary lesions

The purpose of this study was to evaluate the applica-bility of ultrasound-guided percutaneous biopsy for the diagnosis and differentiation of various pulmonary lesions in a Chinese population. A total of 338 pulmonary lesions were biopsied with 18-gauge cutting needles, guided by ultrasound, and sent for histopathological analy-sis. The ultrasonographic characteristics of these lesions, procedure complications, and histopathological diagnoses were analyzed. Suffi-cient specimen for histopathologic analysis was obtained in 95.64% (351/367), and mild complications occurred in 2.72% (10/367) of the patients. Accurate diagnosis was obtained in 94.03% (315/335) of the patients; 16 were lost to follow-up. Using the combination of shape and echogenicity to distinguish benign vs malignant lesions, diagnos-tic sensitivity and specificity were 57.39 and 95.65%, respectively. No significant difference was found between malignant and benign lesions in blood flow signals. Ultrasound-guided core biopsy is valuable for the diagnosis, management, and prognosis of unknown pulmonary lesions. Shape and echogenicity on ultrasonography correlate well with histo-pathology and provide useful information for distinguishing between benign and malignant lesions. On the contrary, color Doppler is of little value for this purpose.

Carotid arterial intima–media thickness and arterial stiffness in pre-eclampsia: analysis with a radiofrequency ultrasound technique

OBJECTIVE

Whether arterial elasticity is reduced in preeclampsia has been investigated only rarely. This study aimed to characterize in vivo the carotid arterial intima–media thickness (IMT) and mechanical properties in women with pre-eclampsia by employing a radiofrequency ultrasound technique.

METHODS

We included 22 late-onset pre-eclamptic pregnant women and 28 normotensive pregnant women who were matched for age (29 ± 6 vs. 27 ± 3, P=0.09) and gestational age (36.0 ± 3.2 vs. 35.8 ± 2.4 weeks, P=0.802). All women were nulliparous with singleton pregnancy. The pre-eclamptic women had a significantly higher arterial pressure than did the normotensive women (P<0.0001). All women underwent right common carotid arterial measurements with an ultrasound machine equipped with automatic Quality IMT (QIMT) and Quality Arterial Stiffness (QAS) capability. At follow-up examination 18 months after parturition, measurements were repeated in 10 of the pre-eclamptic women and 11 of the normotensive women.

RESULTS

In pre-eclamptic compared with normotensive pregnancy, carotid arterial IMT (459 ± 95 vs. 351 ± 85 μm, P=0.0001), internal diameter (7.8 ± 0.5 vs. 7.2 ± 0.4 mm, P<0.0001), pulse wave velocity (7.1 ± 1.7 vs. 6.0 ± 1.5 m/s, P=0.007), augmentation index (7.9 ± 9.2 vs. −5.0 ± 5.6%, P<0.0001) and arterial wall tension (55.0 ± 6.5 vs. 38.6 ± 4.9 mmHg/cm, P<0.0001) were significantly greater, and the distensibility coefficient (0.020 ± 0.009 vs. 0.029 ± 0.011 1/kPa, P=0.006) was significantly smaller, remaining so after adjusting for body mass index and carotid arterial pressure. Eighteen months after parturition, carotid arterial internal diameter, pressure and wall tension remained greater in the pre-eclamptic group.

CONCLUSION

Carotid arterial remodeling, including changes in arterial internal diameter and wall thickness, and arterial stiffening occur in pre-eclampsia but this may reverse, to some extent, postpartum. QIMT and QAS techniques together could provide a comprehensive assessment of carotid arterial remodeling.

Inhibitory activities of baicalin against renin and angiotensin-converting enzyme

CONTEXT

Baicalin has been characterized as the active compound and quality control marker in Scutellaria baicalensis Georgi, traditionally used as a hypotensive herb.

OBJECTIVES

To investigate the inhibitory activities of baicalin against renin and angiotensin-I converting enzyme (ACE) and their molecule mechanism of interactions.

METHODS

The fluorescence method using renin substrate 1(R-2932) and the spectroscopy method by Cushman were used to determine renin and ACE activities, respectively. The fluorescence quench techniques were used to characterize their interactions.

RESULTS

The results showed that baicalin inhibited renin activity with an IC(50) value of 120.36 µM and inhibited ACE activity with an IC(50) value of 2.24 mM in vitro. The fluorescence emission of both renin and ACE were efficiently quenched by baicalin and a complete quenching was achieved at a high concentration of baicalin. Furthermore, baicalin was more effective in quenching the fluorescence of renin (K(SV) = 60 × 10(3) M(-1)) than ACE (K(SV) = 17.1 × 10(3) M(-1)). The quenching of fluorescence of renin and ACE involved static interactions, which was characterized by the formation of quencher-enzyme complex. The baicalin-renin complex formed through three-sites binding including the active site with a binding constant of 796.15 × 10(13) M(-1), but there was only one binding site for the baicalin-ACE complex with a much smaller binding constant of 6.8 × 10(5) M(-1).

CONCLUSION

The inhibition activity of baicalin against renin was a result of the formation of stable complex through multisites binding including the active site, which could explain the higher inhibitory efficiency.

Effects of hyperbaric oxygen and platelet derived growth factor on medial collateral ligament fibroblasts

PURPOSE

This study investigated hyperbaric oxygen (HBO2) and platelet-derived growth factor-BB (PDGF-BB) to determine their combined effects on fibroblasts from rabbit medial collateral ligament (MCL).

METHOD

Cells were divided into four groups: (I) Control, (II) HBO2 treatment, (III) PDGF-BB treatment and (IV) HBO2 combined with PDGF-BB treatment. All hyperoxic cells were exposed to 100% O2 at 2.5 atmospheres absolute (ATA) in a hyperbaric chamber for 120 minutes per 48 hours. Measurement of cell growth was based on increase in cell number. Cell cycle modulations were analyzed by fluorescence-activated cell sorter (FACS). Quantity of Type I and Type III collagen was determined by western blotting and image analyzer.

RESULTS

Treatment doses of HBO2 alone or PDGF-bb alone dependently increased cell growth. A combination of HBO2 treatment plus PDGF-bb treatment had an additive effect on cell growth in comparison with HBO2 treatment alone or PDGF-bb treatment alone. FACS analysis revealed that HBO2 alone, PDGF-bb alone and PDGF-bb plus HBO2 treatment increase the percentage of cells accumulated in S-phase. Western blotting analysis revealed that Type III collagen content was decreased significantly after HBO2 treatment alone or HBO2 plus PDGF-bb treatment but not in PDGF-bb treatment alone. In contrast, although Type I collagen content was increased after HBO2 treatment, the increase in Type I collagen (increase /original) was not statistically significant.

CONCLUSION

HBO2 or HBO2 plus PDGF-bb treatment decreases the Type III collagen/Type I collagen content, which could result in mechanically stronger collagen fibrils. We propose HBO2 therapy as a potentially effective treatment for MCL healing.

Surgical treatment for pathological long bone fracture in patients with multiple myeloma: a retrospective analysis of 22 cases

BACKGROUND

The purpose of this study was to retrospectively review the cases of pathologic long bone fractures caused by multiple myeloma treated in our hospital, to analyze the surgical method, complications, radiation therapy, survival time, and influence on quality of life.

METHODS

In a retrospective study, 22 patients with the pathological long bone fractures due to multiple myeloma who were surgically treated between 1987 and 1997 were analyzed. All patients received open reduction and internal fixation either with plates or intra-medullary nailing. Cement augmentations were performed in the majority of cases (91%). A detailed retrospective analysis was done to correlate the surgical methods, radiation therapy, functional results, and complications post-surgically.

RESULTS

The most common site of fracture was the femur. The mean postoperative survival time was around 19 months. Post-operative pain relief was satisfactory, and only two patients required narcotics. No major complications were observed. However the union rate was only 30%, which might have been due to the inhibitory effect of radiation therapy on bone healing, or insufficient osteogentic ability of the myeloma-involved bone.

CONCLUSION

Satisfactory pain relief and low implant failure rate was achieved and no definite evidence of tumor dissemination was found in this study. The authors suggest that open reduction and internal fixation with cement augmentation is a favorable treatment option for those patients suitable for surgery. However, postoperative radiation therapy may be associated with a low rate of union.

Vascularized island pedicle iliac bone grafting for avascular necrosis of the femoral head

BACKGROUND

Nontraumatic avascular necrosis of the femoral head is a common disorder causing disability of the hip joint. The methods for optimally treating this disease in active young patients are still controversial. In this study we investigated the surgical outcome of vascularized pedicle iliac bone grafting for treating nontraumatic avascular necrosis of the femoral head.

METHODS

Between 1994 and 1999, we treated 100 cases of avascular necrosis of the femoral head with vascularized pedicle iliac bone grafting. Thirty-nine hips in 33 patients were followed-up longer than 24 months. These patients included 30 men and 3 women, with an average age of 40 years. Steinberg's classification and Ohzono's types were used to categorize the diseased hips. The clinical results were evaluated using Charnley's modification of Merle d'Aubigne and Postel's numeric classification.

RESULTS

Of the 33 patients, 82% were satisfied with their decision to have vascularized pedicle iliac bone grafting for avascular necrosis of the femoral head. No serious complications arose during this study. The average operation time for vascularized pedicle iliac bone grafting was 3.5 hours for one team. The rate of conversion to replacement arthroplasty was 10.3% (4 of 39 patients).

CONCLUSION

Vascularized pedicle iliac bone grafting is a useful alternative treatment option for patients with avascular necrosis of the femoral head.

Shape-based grey-level image interpolation

The three-dimensional (3D) object data obtained from a CT scanner usually have unequal sampling frequencies in the x-, y- and z-directions. Generally, the 3D data are first interpolated between slices to obtain isotropic resolution, reconstructed, then operated on using object extraction and display algorithms. The traditional grey-level interpolation introduces a layer of intermediate substance and is not suitable for objects that are very different from the opposite background. The shape-based interpolation method transfers a pixel location to a parameter related to the object shape and the interpolation is performed on that parameter. This process is able to achieve a better interpolation but its application is limited to binary images only. In this paper, we present an improved shape-based interpolation method for grey-level images. The new method uses a polygon to approximate the object shape and performs the interpolation using polygon vertices as references. The binary images representing the shape of the object were first generated via image segmentation on the source images. The target object binary image was then created using regular shape-based interpolation. The polygon enclosing the object for each slice can be generated from the shape of that slice. We determined the relative location in the source slices of each pixel inside the target polygon using the vertices of a polygon as the reference. The target slice grey-level was interpolated from the corresponding source image pixels. The image quality of this interpolation method is better and the mean squared difference is smaller than with traditional grey-level interpolation.

A feasibility study of the in vivo prompt gamma activation analysis using a mobile nuclear reactor

A facility for in vivo prompt gamma activation analysis using moderated neutron beams from a 0.1 W mobile nuclear reactor is described. The low-power nuclear reactor provides total neutron flux of 3.3 X 10(4)n cm-2 s-1 on the surface of a vertical beam tube to which a liquid phantom is positioned. The capability of such a partial-body irradiation facility is demonstrated by measuring trace amounts of toxic cadmium in kidney. The detection limit of Cd in kidney for a skin dose of 1.66 mSv (166 mrem) is 1.34 mg under 500 s irradiation. This facility therefore combines the advantages of mobility with high sensitivity of detection of a toxic element under low neutron and gamma doses.