Tianbing Wang

Accurate Determination of Isthmus of Lumbar Pedicle : A Morphometric Study using Reformatted Computed Tomographic Images

Study Design. Lumbar pedicle isthmus, the narrowest section of pedicle, was investigated. Objective. To determine the lumbar pedicle isthmus accurately and measure related parameters. Summary of Background Data. Accurate anatomic knowledge of pedicle parameters is critical for a successful transpedicular procedure. Many studies on lumbar pedicle dimensions have been conducted, yet less is known about how to obtain these data and their veracity. In fact, the narrowest section is present in the pedicle, i.e., the isthmus of the pedicle. This is the bottleneck of the pedicle; to determine and measure it could illustrate the true morphologic characteristics of the lumbar pedicle. Methods. Ultra high-speed spiral CT scan of lumbar spine was performed in 41 patients of Chinese origin. After reformation of the original images, isthmus and transverse plane of pedicle axis were determined. Eleven dimensions of isthmus plane and three dimensions of transverse plane were calculated using software. Results. Pedicle endosteal width and height in female patients who were over the age of 50 were greater than those of female patients younger than 50 years old. The isthmus endosteal width from L1 to L5 was 5.2, 6.0, 7.5, 7.5, and 8.7 mm and 4.0, 4.1, 5.4, 5.7, and 7.1 mm, respectively, in men and women. Isthmus inclination inclined to midline with less than 10° above L3 but increased in L4 and 30° in L5. Conclusions. An objective narrowest section, the pedicle isthmus, exists in lumbar pedicle axis. The parameters of isthmus, especially isthmus endosteal width, show the morphologic characteristics of the lumbar pedicle and are the most important data provided for transpedicular procedures. The small pedicles of female patients over the age of 50 also show certain primary osteoporosis. Isthmus inclination puts the pedicle in a more complicated space position. A better understanding of the complicated structure of the pedicle isthmus guarantees success in transpedicular procedures.

Biodegradable Conduit Small Gap Tubulization for Peripheral Nerve Mutilation: A Substitute for Traditional Epineurial Neurorrhaphy

Nerve regeneration and re-innervation are usually difficult after peripheral nerve injury. Epineurium neurorrhaphy to recover the nerve continuity is the traditional choice of peripheral nerve mutilation without nerve defects, whereas the functional recovery remains quite unsatisfactory. Based on previous research in SD rats and Rhesus Monkeys, a multiple centers clinical trial about biodegradable conduit small gap tubulization for peripheral nerve mutilation to substitute traditional epineurial neurorrhaphy was carried out. Herein, the authors reviewed the literature that focused on peripheral nerve injury and possible clinical application, and confirmed the clinical possibilities of biodegradable conduit small gap tubulization to substitute traditional epineurial neurorrhaphy for peripheral nerve mutilation. The biodegradable conduit small gap tubulization to substitute traditional epineurial neurorrhaphy for peripheral nerve mutilation may be a revolutionary innovation in peripheral nerve injury and repair field.

Belief rule-based inference for predicting trauma outcome

A RIMER methodology-based trauma outcome prediction model is developed.The RIMER-based prediction model is fine-tuned and validated using historical data.LR, SVM, and ANN models are developed and compared with the RIMER model.The RIMER model has the best prediction performance among the four models. A belief rule-based inference methodology using the evidential reasoning approach (RIMER) is employed in this study to construct a decision support tool that helps physicians predict in-hospital death and intensive care unit admission among trauma patients in emergency departments (EDs). This study contributes to the research community by developing and validating a RIMER-based decision tool for predicting trauma outcome. To compare the prediction performance of the RIMER model with those of models derived using commonly adopted methods, such as logistic regression analysis, support vector machine (SVM), and artificial neural network (ANN), several logistic regression models, SVM models, and ANN models are constructed using the same dataset. Five-fold cross-validation is employed to train and validate the prediction models constructed using four different methods. Results indicate that the RIMER model has the best prediction performance among the four models, and its performance can be improved after knowledge base training with historical data. The RIMER tool exhibits strong potential to help ED physicians to better triage trauma, optimally utilize hospital resources, and achieve better patient outcomes.

Road traffic injury and rescue system in China

Lobo MD, Sobotka PA, Stanton A, et al. Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial. Lancet 2015; 385: 1634–41— On the fourth page of this Article, the sentence starting on line 5 should read “17 patients (n=10 in the arteriovenous coupler group and n=7 in the control group) had previously undergone renal denervation beyond 6 months of enrolment”, and in the panel Research in context, reference 17 should have been reference 19. These corrections have been made to the online version as of April 24, 2015, and the printed Article is correct.

Radiological evaluation of reduction loss in unstable proximal humeral fractures treated with locking plates.

PURPOSE The aim of this study was to radiologically evaluate the risk of reduction loss after locking plate fixation of proximal humerus fractures. METHODS From September 2007 to April 2009, 71 patients (28 males, 43 females) with unstable proximal humeral fracture were treated with open reduction and internal fixation by locking plate. The mean follow-up time was 31.2 months (range: 26-47). The head-shaft angulation (HSA) and the humeral head height (HHH) in true anteroposterior (AP) were recorded and compared over time. All complications were noted. Shoulder function was measured by the Constant score. RESULTS Patients with ΔHSA >10° (t=2.740, P=0.008) and ΔHHH >5mm (t=2.55, P=0.019) were more likely to have impaired shoulder function. Varus collapse occurred most frequently in patients with initial reduction of HSA <125° (χ(2)=19.17, P<0.001, Fishers exact test F<0.001). Patients with >5mm HHH decrease were strongly associated with loss of reduction (χ(2)=24.23, P<0.001, F<0.001). CONCLUSIONS Dynamic change of HSA >10° and HHH >5mm were radiological factors that indicated poor shoulder function. Intra-operative HSA >125° should be achieved to avoid reduction loss following locking plate fixation of proximal humerus fracture. LEVEL OF EVIDENCE level IV.

Incidence of venous thromboembolism and hemorrhage related safety studies of preoperative anticoagulation therapy in hip fracture patients undergoing surgical treatment: a case–control study

BackgroundVenous thromboembolism is a common postoperative complication following orthopedic surgeries, with morbid and potentially fatal consequences. Perioperative low-molecular-weight heparin (LMWH) therapy can reduce the incidence of venous thromboembolism, but may also increase the risk of bleeding complications. Current literature reflects the need to balance the improved efficacy of early initiating prophylaxis with increased risk of perioperative bleeding. The purpose of this study was to compare the effectiveness and hemorrhage related safety of preoperative versus postoperative LMWH therapy for prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) in hip fracture patients.MethodsWe retrospectively evaluated 222 patients who underwent surgical treatment at Peking University Peoples Hospital between January 2009 and December 2010. Patients were allocated to two groups, receiving either preoperative or postoperative initiation of LMWH therapy for venous thromboembolism prophylaxis. Preoperative anticoagulation therapy was initiated 1–12 days prior to surgery (133 patients), and postoperative anticoagulation therapy was initiated 12 h after completion of surgery (89 patients). The preoperative group was further subdivided into four subgroups according to the time of initiation of therapy: 1–3 days before surgery (group A, 54 patients), 4–6 days before surgery (group B, 57 patients), 7–9 days before surgery (group C, 15 patients), and 10–12 days before surgery (group D, 7 patients). Occurrences of DVT, PE, adverse drug effects, intraoperative and postoperative bleeding were recorded, along with concentrations of preoperative and postoperative hemoglobin and length of hospital stay. The above parameters were compared between groups.ResultsAmong recipients of preoperative anticoagulation therapy, two patients developed postoperative PE (1.5 %), one patient developed DVT (0.75 %). In the group receiving postoperative initiation of anticoagulation therapy, one patient each developed PE and DVT (1.1 %, 1.1 %). There was no difference in the occurrence of PE and DVT between the two groups (P>0.05, Chi-square tests). We identified the incidences of major bleeding, minor bleeding, and intraspinal hematoma after spinal anesthesia, which were 0 %/0 %, 3.76 %/3.37 %, and 0 %/0 %, respectively in preoperative and postoperative anticoagulation groups. There was no significant difference in the incidence of bleeding complications between patients receiving preoperatively initiated LMWH with patients receiving postoperatively initiated LMWH. Spinal anesthesia was administered to 168 patients, with no cases of postoperative intraspinal hematoma.ConclusionsPreoperative anticoagulation therapy with LMWH may not increase intraoperative or postoperative blood loss, or the rate of intraspinal hematoma after spinal anesthesia, but also does not significantly reduce the risk of postoperative DVT or PE, compared to postoperative initiation.

One-stage human acellular nerve allograft reconstruction for digital nerve defects.

Human acellular nerve allografts have a wide range of donor origin and can effectively avoid nerve injury in the donor area. Very little is known about one-stage reconstruction of digital nerve defects. The present study observed the feasibility and effectiveness of human acellular nerve allograft in the reconstruction of < 5-cm digital nerve defects within 6 hours after injury. A total of 15 cases of nerve injury, combined with nerve defects in 18 digits from the Department of Emergency were enrolled in this study. After debridement, digital nerves were reconstructed using human acellular nerve allografts. The patients were followed up for 6-24 months after reconstruction. Mackinnon-Dellon static two-point discrimination results showed excellent and good rates of 89%. Semmes-Weinstein monofilament test demonstrated that light touch was normal, with an obvious improvement rate of 78%. These findings confirmed that human acellular nerve allograft for one-stage reconstruction of digital nerve defect after hand injury is feasible, which provides a novel trend for peripheral nerve reconstruction.

Electrical stimulation does not enhance nerve regeneration if delayed after sciatic nerve injury: the role of fibrosis.

Electrical stimulation has been shown to accelerate and enhance nerve regeneration in sensory and motor neurons after injury, but there is little evidence that focuses on the varying degrees of fibrosis in the delayed repair of peripheral nerve tissue. In this study, a rat model of sciatic nerve transection injury was repaired with a biodegradable conduit at 1 day, 1 week, 1 month and 2 months after injury, when the rats were divided into two subgroups. In the experimental group, rats were treated with electrical stimuli of frequency of 20 Hz, pulse width 100 ms and direct current voltage of 3 V; while rats in the control group received no electrical stimulation after the conduit operation. Histological results showed that stained collagen fibers comprised less than 20% of the total operated area in the two groups after delayed repair at both 1 day and 1 week but after longer delays, the collagen fiber area increased with the time after injury. Immunohistochemical staining revealed that the expression level of transforming growth factor β (an indicator of tissue fibrosis) decreased at both 1 day and 1 week after delayed repair but increased at both 1 and 2 months after delayed repair. These findings indicate that if the biodegradable conduit repair combined with electrical stimulation is delayed, it results in a poor outcome following sciatic nerve injury. One month after injury, tissue degeneration and distal fibrosis are apparent and are probably the main reason why electrical stimulation fails to promote nerve regeneration after delayed repair.

Comparison of Road Traffic Injury Characteristics between Local versus Floating Migrant Patients in a Tertiary Hospital between 2007 and 2010

Background The aim of this study is to give a description of the road traffic injuries (RTIs) characteristics of floating migrant population by comparing with those of local residents in a harbor city of China. Methods A population-based descriptive study was carried out between 2007 and 2010 with RTI patient records from the Fifth Center Hospital of Tianjin. Inpatient diagnoses of RTI patients were defined using the International Classification of Diseases, Tenth Revision (ICD-10) codes. We analyzed the demographics and general characteristics of RTI patients that were in the hospital during the four years. In order to compare the group differences between local resident patients and floating migrant patients, the distribution of their ages, diagnoses, severity of injuries, duration of inpatient stays, hospitalization cost were analyzed. Results People between the ages of 16 and 55 were the most likely to suffer RTIs. The floating migrant patients between the ages of 16 and 45 had a higher incidence of accidents, while local resident patients between 46 and 55 had a higher incidence of accidents. Compared to local resident patients, floating migrant patients were more vulnerable to open injuries and severe traffic injuries. With the severity of injuries ranked from mild to severe, floating migrant patients had lower duration of inpatient stay, but higher hospitalization costs compared to local resident patients. Conclusions Floating migrant patients had a different age distribution, severity of injuries, diseases, inpatient duration and hospitalization cost compared with local resident patients. Compared to local resident patients, floating migrants had a higher risk to RTIs and were more vulnerable to severer traffic accidents at lower ages.

Changes and trends of pre-hospital emergency disease spectrum in Beijing in 2003–12: a retrospective study

Abstract Background Pre-hospital emergency call is a crucial indicator of emergency disease spectrum. Since Beijing has changed substantially in economy and population, analysis of the trend of the emergency disease spectrum can greatly contribute to pre-hospital emergency planning. Methods In this 10-year retrospective study, pre-hospital emergency records of Beijing Emergency Medical Center, the only pre-hospital emergency system of Beijing Government, in 2003–12 were collected. Medical Priority Dispatch System was used to classify the call demands. Linear regression models were used to examine the trends. This study was exempt from ethical approval. Findings 2 410 575 cases were collected. Non-pre-hospital requests, which were identified when the crew arrived, were excluded. Uncompleted and unidentified cases were further excluded, and 2 278 415 cases (94·5%) were included in the analysis. The number of pre-hospital emergency call demands soared from 150 656 in 2003 to 309 297 in 2012 (205·3%; p=0·158). The top five call demands throughout the decade were trauma-related demands (25·4%, including falls [5·0%], traffic or transportation incidents [7·2%], and traumatic injuries [13·1%]), general injuries (17·7%), heart problems (11·4%), unconsciousness or fainting (10·0%), and breathing problems (8·1%). These were also the top five fastest growing call demands. Interpretation Compared with the population growth in 2003–12 (145·4%), pre-hospital emergency calls increased much more, which shows a growing demand for ambulance service. By contrast with cities in developed countries, the proportion of trauma-related cases was constantly the highest among call demands, much higher than that in San Francisco (15·7%) in 2009, and is continuously increasing. This could be a result of accelerated city construction and rapid rise in vehicle quantity (244·8%). On the basis of the changes and trends of pre-hospital emergency disease spectrum, specific training programmes for emergency medical service staff and improvement in related medical devices are recommended. Funding Research Special Fund for Public Welfare Industry of Health from the National Health and Family Planning Commission of China.