Objective:Pelvic organ prolapse(POP)is a common condition in postmenopausal women,with an increasing prevalence due to aging.Some women experience POP recurrence after surgical treatment,significantly affecting their ...Objective:Pelvic organ prolapse(POP)is a common condition in postmenopausal women,with an increasing prevalence due to aging.Some women experience POP recurrence after surgical treatment,significantly affecting their physical and mental health.The uterosacral ligament is a critical pelvic support structure.This study aims to investigate the molecular pathological changes in the uterosacral ligament of postmenopausal women with recurrent POP using transcriptomic analysis.Methods:Transcriptomic data of uterosacral ligament tissues were obtained from the public dataset GSE28660,which includes samples from 4 postmenopausal women with recurrent POP,4 with primary POP,and 4 without POP.Differentially expressed genes(DEGs)were identified between recurrent POP and both primary and non-POP groups.Further analysis included intersection analysis of DEGs,gene ontology enrichment,protein protein interaction(PPI)network construction,gene set enrichment analysis(GSEA),single-sample GSEA,and xCell immune cell infiltration analysis to explore molecular pathological changes in recurrent POP.Additionally,histological and molecular differences in the uterosacral ligament were compared between simulated vaginal delivery(SVD)rat models with and without ovariectomy.Results:Compared with primary POP and non-POP groups,recurrent POP exhibited activation of adipogenesis and inflammation-related pathways,while pathways related to muscle proliferation and contraction were downregulated in the uterosacral ligament.Nine key DEGs(ADIPOQ,FABP4,IL-6,LIPE,LPL,PCK1,PLIN1,PPARG,and CD36)were identified,with most enriched in the peroxisome proliferator-activated receptor(PPAR)signaling pathway.These genes were significantly correlated with lipid accumulation,monocyte infiltration,and neutrophil infiltration in the uterosacral ligament.Urodynamic testing revealed that the bladder leak point pressure was significantly higher in ovariectomized SVD rats,both of which had higher values than the sham group.Masson staining showed pronounced adipogenesis in the uterosacral ligament of ovariectomized SVD rats,along with reduced collagen and muscle fibers compared to the sham and non ovariectomized SVD groups.Furthermore,real-time RT-PCR confirmed significantly elevated expression of key DEGs,including ADIPOQ,IL-6,PCK1,and PLIN1,in the uterosacral ligaments of ovariectomized SVD rats.Conclusion:Adipogenesis and inflammation in the uterosacral ligament may contribute to its reduced supportive function,potentially leading to recurrence POP in postmenopausal women.展开更多
Objective:While age has been recognized as a noteworthy factor in preoperative graft selection,the correlation between age and hamstring autograft diameter has been the subject of continued debate within the scientifi...Objective:While age has been recognized as a noteworthy factor in preoperative graft selection,the correlation between age and hamstring autograft diameter has been the subject of continued debate within the scientific community.This study aimed to explore the correlation between the diameter of autologous tendon grafts and age in anterior cruciate ligament reconstruction(ACLR).Methods:A retrospective review of 388 patients who underwent arthroscopic ACLR with hamstring autografts was performed.Patients were grouped by age to analyze differences in hamstring autograft dia-meter and tendon cross-sectional area(CSA).We explored the correlations between age and graft diameter and between age and the CSA of the popliteal tendon while controlling for the influence of other pertinent variables.Results:Compared with female patients,male patients presented significantly greater autograft diameters and hamstring tendon CSAs(P<0.05).Notably,graft diameter and hamstring tendon CSA varied significantly across different age groups(P<0.05);patients aged>32 years were substantially more likely to have a graft diameter exceeding 8 mm and a CSA surpassing 18.5 mm^(2) than their≤32-year-old counterparts were(P<0.05).Conclusion:This study revealed that graft diameter varies across different age groups,with age independently influencing graft diameter.展开更多
Objectives: To investigate foot transverse arch biomechanical stability contributed by the second metatarsal and the three ligaments connecting medial cuneiform to the second metatarsal base.Methods: Six fresh-frozen ...Objectives: To investigate foot transverse arch biomechanical stability contributed by the second metatarsal and the three ligaments connecting medial cuneiform to the second metatarsal base.Methods: Six fresh-frozen cadaveric lower extremities were dissected to expose the展开更多
目的探讨超声引导下弓状韧带上腰方肌阻滞与竖脊肌阻滞对后路腰椎手术患者术后早期康复的影响。方法选择择期行后路腰椎手术患者93例,性别不限,年龄25~70岁,体质量指数(BMI)18~30 kg/m2,ASA分级Ⅱ~Ⅲ级,随机分为3组。Q组超声引导下弓状...目的探讨超声引导下弓状韧带上腰方肌阻滞与竖脊肌阻滞对后路腰椎手术患者术后早期康复的影响。方法选择择期行后路腰椎手术患者93例,性别不限,年龄25~70岁,体质量指数(BMI)18~30 kg/m2,ASA分级Ⅱ~Ⅲ级,随机分为3组。Q组超声引导下弓状韧带上腰方肌阻滞联合全麻,E组超声引导下竖脊肌阻滞联合全麻,N组单纯全麻。3组患者术后均采用静脉自控镇痛泵(PCIA)。记录3组患者苏醒时、术后6、12、24 h的Richmond躁动-镇静(RASS)评分和伯格曼舒适度量表(BCS)评分;记录PCA使用结束Likert量表评分;记录术前1 d和术后1、3 d的匹兹堡睡眠质量指数(PSQI)及术后早期康复质量指标(QoR-15);记录术后苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间、首次下床时间、术后住院时间及术后48 h内不良反应发生情况。结果(1)与N组比较,Q组术后各时点RASS评分较低且BCS评分较高,PCA使用结束后Likert评分1级比例更高(P<0.05);E组苏醒时、术后24 h RASS评分较N组低,苏醒时、术后6、24 h BCS评分较N组高(P<0.05);与E组比较,Q组术后12 h RASS评分较低且BCS评分较高(P<0.05)。(2)Q组与N组比较,术后1、3 d PSQI评分较低且QoR-15评分较高(P<0.05);而E组与N组比较,PSQI评分差异无统计学意义(P>0.05),E组仅在术后1 d QoR-15评分较N组高(P<0.05)。(3)与N组比较,Q组苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间及首次下床时间均显著缩短(P<0.05);E组仅首次肛门排气时间短于N组(P<0.05);Q组出复苏室时间较E组缩短(P<0.01)。(4)三组患者不良反应发生率差异无统计学意义(P>0.05)。结论超声引导下弓状韧带上腰方肌阻滞和竖脊肌阻滞均能有效改善术后镇痛效果与早期康复质量,但弓状韧带上腰方肌阻滞在提升患者舒适度和镇痛满意度、促进睡眠质量及加速术后整体恢复方面更具优势。展开更多
目的:探讨颈后路术后早期(术后3个月)发生神经功能恶化患者长期随访的预后情况及相关危险因素。方法:回顾性分析17例在2006年1月~2012年12月间在我科接受保留一侧肌肉韧带复合体的颈后路椎管扩大成形术后早期神经功能恶化(术后3个月随访...目的:探讨颈后路术后早期(术后3个月)发生神经功能恶化患者长期随访的预后情况及相关危险因素。方法:回顾性分析17例在2006年1月~2012年12月间在我科接受保留一侧肌肉韧带复合体的颈后路椎管扩大成形术后早期神经功能恶化(术后3个月随访时mJOA评分较术前下降≥1分)的患者,以术后10年随访时m JOA评分是否恢复至术前水平将患者分为未恢复组(n=5)及恢复组(n=12),收集两组患者的基线信息、围术期资料及术后3个月、1年和10年时的改良日本骨科协会(modified Japanese Orthopaedic Association,mJOA)评分、颈椎功能障碍指数(neck disability index,NDI)、视觉模拟量表(visual analog scale,VAS)评分和影像学数据[包括Cobb角、颈椎活动度(range of motion,ROM)以及C2-C7矢状面轴向距离(sagittal vertical axis,SVA)]。比较两组患者历次随访时上述指标的差异并进行回归分析,并比较发生早期神经功能恶化时两组患者mJOA评分不同项目是否存在差异。结果:未恢复组患者合并颈椎后纵韧带骨化(ossification of longitudinal ligament,OPLL)比例明显高于恢复组,两组间在年龄、性别、体重指数、合并症、合并脊髓T2高信号、合并发育性颈椎管狭窄等基线信息以及围术期手术时间、出血量、住院时间等均无统计学差异(P>0.05)。未恢复组中1例患者发生脑脊液漏及C5神经根麻痹,恢复组中1例患者发生脑脊液漏,两组间差异无统计学意义。在术后3个月发生早期神经功能恶化后,所有患者完善影像学检查后未见减压不充分,均未行二期手术治疗。未恢复组与恢复组患者术前mJOA评分分别为13.30±2.46分及14.71±1.41分,差异无统计学意义。在发生早期神经功能恶化后,恢复组患者术后1年随访mJOA评分较术后3个月随访明显改善且与术前水平无显著性差异,术后10年随访时显著性高于术前及历次随访;未恢复组患者术后1年和10年随访时mJOA评分与术后3个月发生神经功能早期恶化时无统计学差异。两组间VAS评分及NDI评分在术前及历次随访无统计学差异;两组组内术前及历次随访时的VAS评分及NDI亦无统计学差异。恢复组历次随访时Cobb角较术前均有所增加,术后10年随访时SVA较术前增加明显;未恢复组历次随访时Cobb角及SVA与术前相比差异均无统计学意义。恢复组ROM在术后历次随访中均较术前显著性减小,未恢复组术后较术前无统计学差异。两组间术前及历次随访时Cobb角、ROM及SVA均无显著性差异。未恢复组患者发生早期神经功能恶化时更易累及下肢运动功能。对两组患者进行Logistic回归分析显示术前合并OPLL是发生术后早期神经功能恶化且术后10年难以恢复的危险因素。结论:术前合并OPLL的患者术后发生早期神经功能恶化后长期随访期更难以恢复。展开更多
基金supported by the Key Research and Development Program of Hunan Province(2023SK2038)the Natural Science Foundation of Hunan Province(2024JJ8121),China。
文摘Objective:Pelvic organ prolapse(POP)is a common condition in postmenopausal women,with an increasing prevalence due to aging.Some women experience POP recurrence after surgical treatment,significantly affecting their physical and mental health.The uterosacral ligament is a critical pelvic support structure.This study aims to investigate the molecular pathological changes in the uterosacral ligament of postmenopausal women with recurrent POP using transcriptomic analysis.Methods:Transcriptomic data of uterosacral ligament tissues were obtained from the public dataset GSE28660,which includes samples from 4 postmenopausal women with recurrent POP,4 with primary POP,and 4 without POP.Differentially expressed genes(DEGs)were identified between recurrent POP and both primary and non-POP groups.Further analysis included intersection analysis of DEGs,gene ontology enrichment,protein protein interaction(PPI)network construction,gene set enrichment analysis(GSEA),single-sample GSEA,and xCell immune cell infiltration analysis to explore molecular pathological changes in recurrent POP.Additionally,histological and molecular differences in the uterosacral ligament were compared between simulated vaginal delivery(SVD)rat models with and without ovariectomy.Results:Compared with primary POP and non-POP groups,recurrent POP exhibited activation of adipogenesis and inflammation-related pathways,while pathways related to muscle proliferation and contraction were downregulated in the uterosacral ligament.Nine key DEGs(ADIPOQ,FABP4,IL-6,LIPE,LPL,PCK1,PLIN1,PPARG,and CD36)were identified,with most enriched in the peroxisome proliferator-activated receptor(PPAR)signaling pathway.These genes were significantly correlated with lipid accumulation,monocyte infiltration,and neutrophil infiltration in the uterosacral ligament.Urodynamic testing revealed that the bladder leak point pressure was significantly higher in ovariectomized SVD rats,both of which had higher values than the sham group.Masson staining showed pronounced adipogenesis in the uterosacral ligament of ovariectomized SVD rats,along with reduced collagen and muscle fibers compared to the sham and non ovariectomized SVD groups.Furthermore,real-time RT-PCR confirmed significantly elevated expression of key DEGs,including ADIPOQ,IL-6,PCK1,and PLIN1,in the uterosacral ligaments of ovariectomized SVD rats.Conclusion:Adipogenesis and inflammation in the uterosacral ligament may contribute to its reduced supportive function,potentially leading to recurrence POP in postmenopausal women.
基金This work was supported by the Fundamental Research Funds for the Central Universities(WK9110000143)the USTC Research Funds of the Double First-Class Initiative(YD9110002060)the Health Research Program of Anhui(AHWJ2022b060)。
文摘Objective:While age has been recognized as a noteworthy factor in preoperative graft selection,the correlation between age and hamstring autograft diameter has been the subject of continued debate within the scientific community.This study aimed to explore the correlation between the diameter of autologous tendon grafts and age in anterior cruciate ligament reconstruction(ACLR).Methods:A retrospective review of 388 patients who underwent arthroscopic ACLR with hamstring autografts was performed.Patients were grouped by age to analyze differences in hamstring autograft dia-meter and tendon cross-sectional area(CSA).We explored the correlations between age and graft diameter and between age and the CSA of the popliteal tendon while controlling for the influence of other pertinent variables.Results:Compared with female patients,male patients presented significantly greater autograft diameters and hamstring tendon CSAs(P<0.05).Notably,graft diameter and hamstring tendon CSA varied significantly across different age groups(P<0.05);patients aged>32 years were substantially more likely to have a graft diameter exceeding 8 mm and a CSA surpassing 18.5 mm^(2) than their≤32-year-old counterparts were(P<0.05).Conclusion:This study revealed that graft diameter varies across different age groups,with age independently influencing graft diameter.
基金National Natural Science Foundation #30801163,year2008,and#30640058
文摘Objectives: To investigate foot transverse arch biomechanical stability contributed by the second metatarsal and the three ligaments connecting medial cuneiform to the second metatarsal base.Methods: Six fresh-frozen cadaveric lower extremities were dissected to expose the
文摘目的探讨超声引导下弓状韧带上腰方肌阻滞与竖脊肌阻滞对后路腰椎手术患者术后早期康复的影响。方法选择择期行后路腰椎手术患者93例,性别不限,年龄25~70岁,体质量指数(BMI)18~30 kg/m2,ASA分级Ⅱ~Ⅲ级,随机分为3组。Q组超声引导下弓状韧带上腰方肌阻滞联合全麻,E组超声引导下竖脊肌阻滞联合全麻,N组单纯全麻。3组患者术后均采用静脉自控镇痛泵(PCIA)。记录3组患者苏醒时、术后6、12、24 h的Richmond躁动-镇静(RASS)评分和伯格曼舒适度量表(BCS)评分;记录PCA使用结束Likert量表评分;记录术前1 d和术后1、3 d的匹兹堡睡眠质量指数(PSQI)及术后早期康复质量指标(QoR-15);记录术后苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间、首次下床时间、术后住院时间及术后48 h内不良反应发生情况。结果(1)与N组比较,Q组术后各时点RASS评分较低且BCS评分较高,PCA使用结束后Likert评分1级比例更高(P<0.05);E组苏醒时、术后24 h RASS评分较N组低,苏醒时、术后6、24 h BCS评分较N组高(P<0.05);与E组比较,Q组术后12 h RASS评分较低且BCS评分较高(P<0.05)。(2)Q组与N组比较,术后1、3 d PSQI评分较低且QoR-15评分较高(P<0.05);而E组与N组比较,PSQI评分差异无统计学意义(P>0.05),E组仅在术后1 d QoR-15评分较N组高(P<0.05)。(3)与N组比较,Q组苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间及首次下床时间均显著缩短(P<0.05);E组仅首次肛门排气时间短于N组(P<0.05);Q组出复苏室时间较E组缩短(P<0.01)。(4)三组患者不良反应发生率差异无统计学意义(P>0.05)。结论超声引导下弓状韧带上腰方肌阻滞和竖脊肌阻滞均能有效改善术后镇痛效果与早期康复质量,但弓状韧带上腰方肌阻滞在提升患者舒适度和镇痛满意度、促进睡眠质量及加速术后整体恢复方面更具优势。
文摘目的:探讨颈后路术后早期(术后3个月)发生神经功能恶化患者长期随访的预后情况及相关危险因素。方法:回顾性分析17例在2006年1月~2012年12月间在我科接受保留一侧肌肉韧带复合体的颈后路椎管扩大成形术后早期神经功能恶化(术后3个月随访时mJOA评分较术前下降≥1分)的患者,以术后10年随访时m JOA评分是否恢复至术前水平将患者分为未恢复组(n=5)及恢复组(n=12),收集两组患者的基线信息、围术期资料及术后3个月、1年和10年时的改良日本骨科协会(modified Japanese Orthopaedic Association,mJOA)评分、颈椎功能障碍指数(neck disability index,NDI)、视觉模拟量表(visual analog scale,VAS)评分和影像学数据[包括Cobb角、颈椎活动度(range of motion,ROM)以及C2-C7矢状面轴向距离(sagittal vertical axis,SVA)]。比较两组患者历次随访时上述指标的差异并进行回归分析,并比较发生早期神经功能恶化时两组患者mJOA评分不同项目是否存在差异。结果:未恢复组患者合并颈椎后纵韧带骨化(ossification of longitudinal ligament,OPLL)比例明显高于恢复组,两组间在年龄、性别、体重指数、合并症、合并脊髓T2高信号、合并发育性颈椎管狭窄等基线信息以及围术期手术时间、出血量、住院时间等均无统计学差异(P>0.05)。未恢复组中1例患者发生脑脊液漏及C5神经根麻痹,恢复组中1例患者发生脑脊液漏,两组间差异无统计学意义。在术后3个月发生早期神经功能恶化后,所有患者完善影像学检查后未见减压不充分,均未行二期手术治疗。未恢复组与恢复组患者术前mJOA评分分别为13.30±2.46分及14.71±1.41分,差异无统计学意义。在发生早期神经功能恶化后,恢复组患者术后1年随访mJOA评分较术后3个月随访明显改善且与术前水平无显著性差异,术后10年随访时显著性高于术前及历次随访;未恢复组患者术后1年和10年随访时mJOA评分与术后3个月发生神经功能早期恶化时无统计学差异。两组间VAS评分及NDI评分在术前及历次随访无统计学差异;两组组内术前及历次随访时的VAS评分及NDI亦无统计学差异。恢复组历次随访时Cobb角较术前均有所增加,术后10年随访时SVA较术前增加明显;未恢复组历次随访时Cobb角及SVA与术前相比差异均无统计学意义。恢复组ROM在术后历次随访中均较术前显著性减小,未恢复组术后较术前无统计学差异。两组间术前及历次随访时Cobb角、ROM及SVA均无显著性差异。未恢复组患者发生早期神经功能恶化时更易累及下肢运动功能。对两组患者进行Logistic回归分析显示术前合并OPLL是发生术后早期神经功能恶化且术后10年难以恢复的危险因素。结论:术前合并OPLL的患者术后发生早期神经功能恶化后长期随访期更难以恢复。
