Stem cells for spine surgery

In the past few years, stem cells have become the focus of research by regenerative medicine professionals and tissue engineers. Embryonic stem cells, although capable of differentiating into cell lineages of all three germ layers, are limited in their utilization due to ethical issues. In contrast, the autologous harvest and subsequent transplantation of adult stem cells from bone marrow, adipose tissue or blood have been experimentally utilized in the treatment of a wide variety of diseases ranging from myocardial infarction to Alzheimer’s disease. The physiologic consequences of stem cell transplantation and its impact on functional recovery have been studied in countless animal models and select clinical trials. Unfortunately, the bench to bedside translation of this research has been slow. Nonetheless, stem cell therapy has received the attention of spinal surgeons due to its potential benefits in the treatment of neural damage, muscle trauma, disk degeneration and its potential contribution to bone fusion.     

基于加速康复外科理念的早期康复训练联合八段锦前四式在乳腺癌改良根治术后患者中的应用效果研究

摘要 目的：研究基于加速康复外科（ERAS）理念的早期康复训练联合八段锦前四式在乳腺癌改良根治术后患者中的应用效果。方法：选择2019年9月~2022年5月期间在湖南中医药大学第一附属医院行乳腺癌改良根治术的128例乳腺癌患者。按照随机数字表法将患者分为对照组（基于ERAS理念的早期康复训练,n=64）和研究组（对照组的基础上接受八段锦前四式干预,n=64）。对比两组抑郁自评量表（SDS）评分、健康调查简表（SF-36）、焦虑自评量表（SAS）评分、Constant-Murley肩关节功能评分、疼痛视觉模拟评分（VAS）和肩关节活动度。结果：与对照组相比,研究组干预后SDS、SAS评分更低（P<0.05）。与对照组相比,研究组情感/生理职能、躯体疼痛、社会/生理功能、活力、总体/精神健康评分更高（P<0.05）。与对照组相比,研究组干预后VAS评分更低,Constant-Murley肩关节功能评分更高（P<0.05）。与对照组相比,研究组干预后前屈、后伸、外展关节活动度更大（P<0.05）。结论：基于ERAS的早期康复训练联合八段锦前四式应用于乳腺癌改良根治术后患者,可提高患者的生活质量,可能与缓解焦虑、抑郁情绪,减轻术后疼痛,促进肩关节功能恢复有关。     

不同剂量瑞芬太尼复合小剂量艾司氯胺酮用于腹腔镜妇科手术患者的效果及对麻醉效能、疼痛的影响

摘要 目的：研究不同剂量瑞芬太尼复合小剂量艾司氯胺酮对腹腔镜妇科手术患者麻醉效果的影响。方法：选取2020年4月～2023年2月在本院接受腹腔镜妇科手术治疗的60例患者进行研究,根据瑞芬太尼静脉输注剂量将其分为小剂量组、中剂量组和大剂量组,每组各20例。三组均给予患者小剂量艾司氯胺酮（0.1 μg?kg）,小剂量组给予患者0.1 μg/（Kg?min）瑞芬太尼,中剂量组给予患者0.3 μg/（Kg?min）瑞芬太尼,大剂量组给予患者0.5 μg/（Kg?min）瑞芬太尼。记录三组患者的麻醉起效时间、麻醉诱导时间、拔管时间和不良反应发生率,并检测其不同时间段的血流动力学和疼痛。结果：麻醉起效、麻醉诱导拔管时间比较,三组无显著差异（P＞0.05）。平均动脉压（MAP）和心率（HR）比较,大剂量组和中剂量组T1、T2时间段均低于小剂量组,中剂量组T1、T2时间段低于大剂量组;三组T2时间段MAP、HR水平低于T0、T1时间段,T1时间段低于T0时间段（P＜0.05）。疼痛视觉模拟量表（VAS）评分比较,大剂量组和中剂量组T1、T2时间段均低于小剂量组,中剂量组T1、T2时间段低于大剂量组;三组T2时间段MAP、HR水平低于T0、T1时间段,T1时间段低于T0时间段（P＜0.05）。不良反应发生率比较,三组无显著差异（P＞0.05）。结论：不同剂量瑞芬太尼复合小剂量艾司氯胺酮均能保障腹腔镜妇科手术的麻醉效果和安全性,但中剂量瑞芬太尼的应用更有利于稳定血流动力学,并减轻患者的疼痛程度。     

高血压基底节区脑出血患者血清CXCL1、CXCL10与神经损伤指标和微创穿刺引流术后预后的关系研究

摘要 目的：探讨高血压基底节区脑出血（HBGH）患者血清CXC趋化因子配体1（CXCL1）、CXC趋化因子配体10（CXCL10）与神经损伤指标和微创穿刺引流术后预后的关系。方法：选取2020年2月~2023年4月聊城市人民医院东院区收治的行微创穿刺引流术治疗的HBGH患者162例纳入研究组，选取体检健康的志愿者110例纳入对照组。检测对比两组血清CXCL1、CXCL10和神经损伤指标[神经元特异性烯醇化酶（NSE）、胶质纤维酸性蛋白（GFAP）、S100β蛋白]水平。采用Pearson检验分析血清CXCL1、CXCL10与神经损伤指标的相关性。所有患者均随访3个月，根据改良Rankin量表（mRS）评分分为预后良好组和预后不良组。采用多因素Logistic回归模型分析HBGH患者微创穿刺引流术后预后的影响因素。结果：研究组的血清CXCL1、CXCL10水平高于对照组（P<0.05）。研究组的血清NSE、GFAP、S100β蛋白水平高于对照组（P<0.05）。Pearson检验分析结果显示，血清CXCL1、CXCL10与NSE、GFAP、S100β蛋白均呈正相关（P<0.05）。单因素分析结果显示，预后不良与年龄、甘油三酯（TG）、低密度脂蛋白（LDL）、凝血酶原时间（PT）、C反应蛋白（CRP）、血肿破入脑室、血肿体积、术后24 h内血肿清除率、尿激酶冲管次数、术后颅内出血再发、CXCL1、CXCL10有关（P<0.05）。多因素Logistic回归分析结果显示，年龄偏大、LDL偏高、血肿体积偏大、术后24 h内血肿清除率偏低、尿激酶冲管次数偏多、CXCL1偏高、CXCL10偏高是HBGH患者微创穿刺引流术后预后不良的危险因素（P<0.05）。结论：HBGH患者血清CXCL1、CXCL10水平升高可能导致神经损伤和不良预后。年龄、LDL、血肿体积、术后24 h内血肿清除率、尿激酶冲管次数、CXCL1、CXCL10是HBGH患者术后预后不良的危险因素，值得引起重视。     

右美托咪定联合舒芬太尼术后镇痛对卵巢癌根治术患者细胞免疫功能和炎症应激反应的影响

摘要 目的：探讨右美托咪定联合舒芬太尼术后镇痛对卵巢癌根治术患者细胞免疫功能和炎症应激反应的影响。方法：根据随机数字表法将2020年2月至2023年2月期间陕西省肿瘤医院120例择期行卵巢癌根治术的患者分为对照组（n=60，术后镇痛药物选用舒芬太尼）和研究组（n=60，术后镇痛药物选用右美托咪定联合舒芬太尼）。对比两组镇静（Ramsay镇静评分）、细胞免疫功能[CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺]、镇痛情况[视觉模拟评分法（VAS）]、不良反应、炎症应激反应[白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、皮质醇（Cor）和去甲肾上腺素（NE）]变化情况。结果：与对照组术后6 h、12 h、24 h、48 h 相比，研究组同时间点VAS评分更低，Ramsay镇静评分更高（P<0.05）。与对照组术后24 h相比，研究组同时间点CD3⁺、CD4⁺、CD4⁺/CD8⁺更高，CD8⁺更低（P<0.05）。两组不良反应发生率组间对比未见差异（P>0.05）。与对照组术后24 h相比，研究组同时间点IL-6、TNF-α、Cor、NE更低（P<0.05）。结论：右美托咪定联合舒芬太尼用于卵巢癌根治术患者术后镇痛，镇静、镇痛效果显著，同时还可减轻机体炎症应激反应，缓解免疫抑制。     

心脏术后急性肾损伤的研究进展

急性肾损伤（Acute Kidney Injury,AKI）是心脏术后较常见且较严重的并发症,明显增加患者的住院费用,并且增加手术死亡率。研究发现术前肾功能不全、糖尿病、及外周血管疾病等是术后AKI的危险因素。最新的研究发现一些新的生物学标准物可以为我们早期诊断心脏术后AKI的发生的提供帮助。而一旦出现AKI,选择适当药物治疗和肾脏替代治疗,可以保护肾功能,改善AKI患者的预后。     

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated.     

Monitoring of Systemic and Hepatic Hemodynamic Parameters in Mice

The use of mouse models in experimental research is of enormous importance for the study of hepatic physiology and pathophysiological disturbances. However, due to the small size of the mouse, technical details of the intraoperative monitoring procedure suitable for the mouse were rarely described. Previously we have reported a monitoring procedure to obtain hemodynamic parameters for rats. Now, we adapted the procedure to acquire systemic and hepatic hemodynamic parameters in mice, a species ten-fold smaller than rats. This film demonstrates the instrumentation of the animals as well as the data acquisition process needed to assess systemic and hepatic hemodynamics in mice. Vital parameters, including body temperature, respiratory rate and heart rate were recorded throughout the whole procedure. Systemic hemodynamic parameters consist of carotid artery pressure (CAP) and central venous pressure (CVP). Hepatic perfusion parameters include portal vein pressure (PVP), portal flow rate as well as the flow rate of the common hepatic artery (table 1). Instrumentation and data acquisition to record the normal values was completed within 1.5 h. Systemic and hepatic hemodynamic parameters remained within normal ranges during this procedure.This procedure is challenging but feasible. We have already applied this procedure to assess hepatic hemodynamics in normal mice as well as during 70% partial hepatectomy and in liver lobe clamping experiments. Mean PVP after resection (n= 20), was 11.41±2.94 cmH₂O which was significantly higher (P<0.05) than before resection (6.87±2.39 cmH₂O). The results of liver lobe clamping experiment indicated that this monitoring procedure is sensitive and suitable for detecting small changes in portal pressure and portal flow rate. In conclusion, this procedure is reliable in the hands of an experienced micro-surgeon but should be limited to experiments where mice are absolutely needed.     

静注氟比洛芬酯预防肺叶手术中全麻患者苏醒期躁动的临床研究

目的:探讨肺叶手术中超前应用氟比洛芬酯对减轻全身麻醉苏醒期躁动发生率的影响。方法:60例肺叶切除术患者随机分为A组和B组,每组30例,两组均常规诱导全麻气管插管,术中瑞芬、丙泊酚、维库溴铵泵住维持麻醉,A组于术前给予氟比洛芬酯1 MG/KG。比较两组躁动得分、苏醒后(10 min、30 min、1 h、2 h、4 h、24 h)六个时间点疼痛评分及不良反应发生率。结果:两组出血时间、拔管时间、麻醉时间差异均无统计学意义(均P0.05);A组患者的躁动得分显著低于B组,差异有统计学意义(P0.05);两组的VAS评分差异有统计学意义(P0.05),不同时间点的VAS评分差异有统计学意义(P0.05),分组与时间之间存在交互作用(P0.05);A组患者的不良反应发生率低于B组,差异有统计学意义(P0.05)。结论:肺叶手术中超前应用氟比洛芬酯具有良好的镇痛效果,可以降低全身麻醉苏醒期躁动的发生率。     

腹腔镜手术在泌尿外科的临床效果观察

目的:探讨在泌尿外科中腹腔镜手术的临床治疗效果,对比传统开放手术与腹腔镜手术的差异。方法:选取我院138例泌尿外科手术病人为研究对象,将其随机分为治疗组(腹腔镜手术组)和对照组(传统手术组)两组,每组69例。观察两组病人在手术时间(min)、平均出血总量(mL)、住院天数(d)、置管引流时间(min)、尿管留置时间(mL)、静脉输液时间(d)及并发症几方面的治疗效果分析。结果:与传统手术组相比,腹腔镜手术治疗组在手术时间(min)、平均出血总量(mL)、置管引流时间、导尿管留置时间、静脉输液时间及并发症上均有所减少,住院天数(d)也相应缩短,两组比较有显著差异(P0.05),有统计学意义。结论:在泌尿外科应用腹腔镜技术,具有微创、手术时间短、手术中出血量少、置管引流时间和导尿管留置时间短及并发症少等优点,使病人恢复快、缩短治疗周期,值得临床广泛应用。