ObjectivesTo compare the clinical features and the effects on cognition, emotion, and prognosis of antiepileptic drugs (AEDs) between occipital lobe epilepsy (OLE) and temporal lobe epilepsy (TLE).MethodsWe collected the clinical data of the patients with OLE and TLE from the Department of Neurology, the First Hospital of Jilin University from January 2016 to May 2018. We measured the patients with Mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), digital span, Auditory verbal memory test (AVMT), Generalized anxiety disorder (GAD-7), Patient health questionnaire-9 (PHQ-9) and Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (c-NDDI-E) and followed up for 1 year.Results① After 1 year’s follow-up, the frequency of the two groups decreased compared with the first visit (Z=3.734, P=0.000) and the extent was similar (Z=?0.290, P=0.772). In group OLE, occipital aura was 45.9% (17 cases) and temporal aura was 37.8% (14 cases). In TLE group, temporal aura was 49.3% (33 cases) and occipital aura 7.5% (5 cases). In OLE group, post-seizure headache was found in 17 cases (45.9%), which was more than the 15 cases (22.4%) in TLE group (χ2=6.210, P=0.013). ② 30 cases (81.1%) in OLE group interictal discharge involved lobes outside occipitotemporal lobe, 4 of which had a wide-lead-involved discharge, and 19 cases (28.4%) in TLE group involved lobes outside temporal lobe, and there was a significant difference between the two groups (χ2=26.592, P=0.000). ③ There was no significant difference in the score of MOCA and AVMT in the group of OLE-A and OLE-B, either the group of TLE-A and TLE-B. The score of AVMT in group OLE-A was higher than that in group TLE-A (t=3.193, P=0.002), and that in group OLE-B was higher than that in group TLE-B (t=2.264, P=0.029). There was no significant difference in GAD-7, PHQ-9, and c-NDDI-E (P>0.05). After follow-up for 1 year, the scores were compared with its initial scales. The score of GAD-7 (Z=?2.561, P=0.010), PHQ-9 (Z=?2.053, P=0.040) and c-NDDI-E (Z=?2.493, P=0.013) all decreased. The score of GAD-7 (r=0.281, P=0.021) and c-NDDI-E (r=0.456, P=0.000) have a positive correlation with the frequency of seizure. Therapeutic effect: In OLE group, the efficiency of carbamazepine or oxcarbazepine group was 58.82% and of levetiracetam group was 83.33%. in TLE group, the efficiency of carbamazepine or oxcarbazepine was 72.50% and of levetiracetam group was 70.00%. There was no significant difference between group OLE and group TLE in the curative effect of carbamazepine or oxcarbazepine group (χ2=1.033, P=0.310) or levetiracetam group (χ2=0.356, P=0.551). After 1 year’s follow-up, the frequency of OLE group was 0.00 (0.000, 2.750) times per month, and the TLE group was 0.00 (0.000, 1.500) times per month. There was no significant difference between the two groups (Z=?0.226, P=0.822). At the follow-up, the frequency of seizure in the two groups was lower than that at the first visit (P=0.000). The frequency of seizure in TLE group was similar to that in OLE group (=?0.648, P=0.517). After 1 year, 5 patients (13.51%) in OLE group were newly diagnosed as refractory epilepsy and 6 patients (9.00%) in TLE group There was no significant difference in the rate of the newly diagnosed refractory epilepsy between the two groups (2=0.524, P=0.469).ConclusionOccipital aura and post-seizure headache are specific to OLE, which can be used as one of the basis for diagnosis of OLE. Epileptiform discharge in OLE is more likely to spread out in multiple cerebral lobes, while epileptiform discharge in TLE is confined to temporal lobe and the area near it. The cognitive impairment in OLE or TLE is not related to the duration of the disease. The degree of depression is positively correlated with the frequency of seizure. The responses to AEDs of OLE and TLE are similar.
Rolling enrollment is a common method for participant recruitment in medical practice. In the longitudinal data, where researchers are often interested in outcomes occurring after a certain period of treatment, the definition of causal effects differs from that in the cross-sectional data. It poses new challenges for the application of matching methods in the longitudinal studies. Longitudinal matching is an extension of matching methods in longitudinal studies involving static interventions such as rolling enrollment. Currently, longitudinal matching methods are widely applied in the comparative effectiveness research. This article elucidates the fundamental principles, applicable conditions, code implementation, and application instances of four longitudinal matching methods through theoretical discussions and empirical illustrations. It provides methodological references for estimating causal effects in longitudinal data analysis.
Objective To compare advantage and disadvantage of internal fixation method for tibia intercondylar eminence fracture between absorbable screw and metallic screw. Methods From 1996 to 2002, 200 patients with fracture of tibia intercondylar eminence were divided into group A (with absorbable screw, n=120) andgroup B (with metallic screw, n=80). And the biological compatibility, biomechanics, bone union and complications were compared between two groups.Results There were no obvious differences in operating time and circumstance of recovery position between two groups. Group A was obviously better than group B in biological compatibility, biomechanics, bone union, joint function recovery. The average healing time of group A was three months, that of group B was three and half months. The good rates of joint function in two groups were 98.0% and 95.0% respectively. The occurrence rates of wound arthritis were 1.7% and 3.7%. There wassignificant difference between them(P＜0.01). Conclusion Absorbable screw is a more ideal material of internal fixation to treat tibia intercondylar eminence fracture.
Objective To explore the effective method for treatmentof fracturesof scapular neck.Methods A retrospective analysis of 30 patients with fractures of scapular neck was done. The patients were treated by operation or by nonoperation from May 1994 to May 2003. According to the degree of displacement,30 cases included 9 mild displaced fractures(lt;10 mm) and 21 severe displaced fractures(gt;10 mm). According to the location of fractures, there were 24 cases of surgical neck fractures and 6 cases of anatomical neck fractures. Of all 30 patients, 12 were treated by nonoperation and 18 by operation. All fractured scapularnecks were exposed through posterior approach and fixed with interfragmentary compression screws, reconstruction plates and so on after satisfactory reduction.Associated clavical fractures were exposed through Langer’s approach and fixed with Kirschner wire-tension band fixation construct, reconstruction plates and so forth. When followed up, the clinical examination was done and the X-ray filmswere taken to measure glenopolar angle(GPA). Herscovici’s score was adopted.Results Twenty-eight patients were followed up from 14 days to 9 years. Among 11 patients treated by non-operation, Herscivici score showed that 4 cases achieved the excellent result, 2 cases good, 2 cases fair and 3 cases poor and the X-ray film results showed that there were 6 cases of GPA＞20° and 5 cases of GPA＜20°. Of 17 patients treatedby operation, Herscivici score showed that 11 cases achieved the excellent result, 5 cases good and 1 case fair and the X-ray film results showed that there 16 cases of GPA＞20° and 1 case of GPA＜20°.Conclusion Fractures of scapular surgical neck with mild displacement can be treated by nonoperation, while fractures of surgical neck with severe displacement or associated with ipsilateral clavical fractures, and fractures of anatomical neck should be treated by operation to reconstruct the stabilityof shoulder and minimize the complications.
Objective To explore the effects of various kinds of internal fixations on unstable intertrochanteric femoral fractures. Methods From January 2000 to December 2004,88 cases of unstable intertrochanteric femoral fractures were treated. There were 52 males and 36 females (aged 19-86 years). Twenty-two cases were caused by fall from height, 36 by motor vehicle accident and 20 by fall and 10 by tumble. They were divided into 4 groups according to 4 kinds of internal fixations: dynamic hip screw(DHS,group A, n=42), anatomical proximal femur bone plate (group B, n=23), proximal femoral nail（PFN，group C, n=8）and dynamic condylar screw (DCS, group D, n=15). According to the modified Evan’s classification, fractures were all unstable type and were classified as follow types: group A (15 type Ⅲ, 8 type Ⅳ and 19 type Ⅴ); group B (12 type Ⅲ, 5 type Ⅳ and 6 type Ⅴ); group C (3 type Ⅲ,2 type Ⅳ and 3 type Ⅴ); and group D (10 type Ⅲ,3 type Ⅳ and 2 type Ⅴ). The data of operative time, intra-operative blood loss, intraoperative complications, fluoroscopy exposures, clinical healing time of fracture, post-operative restored function and postoperative complications were recorded and analyzed statistically using the SPSS 12.0 software package.Results All patients were followed up for 12-48 month (18 months on average). All patients achieved clinical healing. Coxa varus occurred in 3 cases of group A, in 1 case ofgroup C and in 3 cases of group D . The differences were of no statistical significance in operative time and postoperative complications between 4 groups (P＞0.05). The difference was of statistical significance in the blood loss between groups A,B and groups C,D (P＜0.05) but no statistical significance between group C and group D (P＞0.05). The difference was of statistical significance in the fluoroscopy exposures, clinical healing time of fracture and postoperative complications between group B and the other groups (P＜0.05). The difference was of statistical significance in the postoperative restored functions between group D and theother groups (P＜0.05). Conclusion The anatomical proximal femur bone plate is a useful device in the treatment of unstable intertrochanteric femoral fracture. The operative manipulation is simple and the hip functions recover well.
Objective To compare the clinical efficacy of glucosamine hydrochloride and Chinese traditional medicine of angelicae pubescentis and loranthi decoction in the treatment of knee osteoarthritis. Methods We included 142 patients with mild-to-moderate knee osteoarthritis treated between January 2014 and July 2015. The patients were randomly divided into treatment group and control group. The 72 patients in the treatment group received glucosamine hydrochloride, while the other 70 patients in the control group took oral Chinese medicine of angelicae pubescentis and loranthi decoction. The treatment course was one month. We observed the clinical curative effect of both the two groups. Results After the treatment, the difference in Visual Analogy Score (VAS) and Severity Index of Osteoarthritis (ISOA) in the two groups were significant compared with those before the treatment (P ＜ 0.05) . There were significant differences between the two groups in terms of VAS pain score, ISOA and treatment effectiveness (P ＜ 0.05) . Conclusion Glucosamine hydrochloride can obviously relieve knee osteoarthritis symptoms and improve knee function, which has a better curative effect than the traditional Chinese medicine of angelicae pubescentis and loranthi decoction.
Objective To verify the effect of palatoplasty with or without velopharyngeal muscular reconstruction on the velar movement through the lateral radiography. Methods From October 1988 to October 2000, 62 patients with cleft palate and velopharyngeal insufficiency were treated. Of them, 32 were repaired by velopharyngeal muscular reconstruction (group A) and 30 by modified von Langenbeck’s procedure (group B). The lateral radiographs and cephalometric analysis were taken. The velopharyngeal closure, velar extensibility, the angle changes of velar elevation, the distance changes of velar levator eminence based on anatomy (LEA) to velopharyngeal closure line (VCL), the varieties in LEA, the comparison of LEA and velar levator eminence based on phonation (LEP), the distance comparison between posterior nasal spine (PNS) to LEA and LEP through soft palate line (SPL) were measured. Results During the phonation, group A was significantly greater than group B in the velopharyngeal closure rate(Plt;0.01)， the velar extensibility(Plt;0.05) and the location comparison between LEA and LEP(Plt;0.01); group B was significantly greater than group A in velar elevation angle (Plt;0.05), the varieties in LEA(Plt;0.05). In velar rest position, the distance of LEA to VCL was greater inB group than in A group(Plt;0.01). There was significant difference in thedistance comparison between LEA and LEP(Plt;0.05), difference between LEA and LEP(Plt;0.01) and the distance PNS-SPL-LEA and PNSSPL-LEP(Plt;0.05) within group B; contrary to the results within group A(P＞0.05). Conclusion The velopharyngeal muscular reconstruction in palatoplasty can result in a near normalizationof anatomic measurement of velar levator muscles and improve the velar functionand velopharyngeal competence. Repositioning of velar muscles in a more anatomic correct, transverse position is more important to improve the velar length andaccordant velar movement with velopharyngeal muscles in functional palatoplasty. The velar angle change and velar elevation during phonation are not determinative factors for velopharyngeal competence.
Objective To compare the outcomes of two operative methods, the anterior decompression in subsection and the anterior decompression in one section, which were used to treat multilevel cervical spondylotic myelopathy (CSM). Methods Data of multilevel CSM undergoing the anterior decompression in subsection (33 cases, the subsection group) and the anterior decompression in one section (19 cases, the one section group) from July 1999 to January 2004 were retrospectively analyzed. The- incidence of perioperative complications and the rate of fusion were evaluated by the postoperative X-ray and MRI examinations, and improvement of the neurological function was evaluated by the JOA score.Results The incidence of perioperative complications was 36.8%in the one section group, mainly including immigration of the plate and grafts,which was settled by the revision surgery; while the incidence of perioperative compilcations was 12.1% in the subsection group, mainly including the immigration of the titanium mesh. There was a significant difference between the two groups (Plt;0.05). 84.2％ of the patients in the one section group and 81.8％ of the patients in the subsection group developed bony fusion by the end of the follow-up (9-31 mon, averaged 112 mon), and there was no significant differencebetween the two groups (Pgt;0.05). According to the JOA score, the ratio of the improvement in the neurological function was 70.4% in the subsection group and 64.4% in the one section group. There was no significant difference between the two groups (Pgt;0.05). Conclusion The anterior decompression in subsection is more rational for the surgical treatment on the multilevel CSM than the anterior decompression in one section. It can provide an equal decompressive effect but a more stable local mechanical environment right after the surgery and can maintain it well, which is critical for the bony fusion.
Objective To explore the neck axial symptom (AS) after Bryan cervical disc arthroplasty traditional anterior cervical discectomy and fusion, and to make contrastive analysis. Methods From October 2004 to April 2006, 22 patients, 13 males and 9 females, aged 33-54 years old (43.3 on average), underwent Bryan cervical disc placement (groupA). Among them, there were 16 cases of cervical spondylotic myelopathy and 6 of nerve root cervical syndrome, with 20of single segment replacement and 2 of two segments replacement. The courses of disease were 1-21 months (6 months on average). Meanwhile, 30 patients, 17 males and 13 females, aged 35-64 years old (50.3 on average) underwent traditional anterior cervical discectomy and fusion (group B). Among them, there were 19 cases of cervical spondylotic myelopathy and 11 of nerve root cervical syndrome, with 26 of single segments replacement and 4 of two segments replacement. The course of disease was 1-23 months (7 months on average). In both groups, the neurologic recovery rate, the change of cervical curvature of the operated segments and total range of motion (ROM), and incidence of neck axial symptoms were recorded and compared. Results All the patients were followed up for 24-42 months (30.6 months on average). There was no graveness compl ication happening during and after operation in both groups. There were no compl ications of prosthesis bit shifting and amotio in group A, and group B exhibited a bony fusion on X-ray films 6 months after operation, without plate and bolt loose or broken. The patients’ cl inical symptoms of radiculopathy were obviously rel ieved and the curative effect was satisfactory in two groups of nerve root cervical syndrome. In both groups of cervical spondylotic myelopathy, the patients’ JOA scores at the postoperative follow-up increased obviously than preoperative (Plt; 0.01), and there was no significant difference between the two groups before the operation and at the end of the follow-up (P gt; 0.05). The rate of sagittal al ignment of the operated segment with kyphosis increased obviously in group B, higher than in group A (P lt; 0.05).The total ROM of group B was obviously lower than preoperative (Plt; 0.01), and the pre- and postoperative difference of group A was not statistically significant (P gt; 0.05). The rate of postoperative neck AS was 18.18% in group A and 46.67% in group B, and the difference was statistically significant(Plt; 0.05). Conclusion Compared with traditional anterior cervical discectomy and fusion, the use of Byran disc arthroplasty for cervical syndrome is associated with good outcomes. At the same time, it can maintain the cervical motion and curvature of operated segments, avoid the decrease of total ROM and lower the incidence of the postoperative neck AS.
Objective To observe the main biological characteristics and chondrogenesis potency of bone marrow -derived stromal cells(MSCs) after cytokinesinduction or gene modification in vitro. Methods MSCs from an adult New Zealand white rabbit were isolated and cultivated, and then MSCs were divided into the common medium group(Group A, 15%FBS in DMEM), the induced group by cytokines (Group B), the transfected group(Group C)with adenovirus-hepatocyte growth factor transgene (adHGF). The medium of group B consisted of transforming growth factor-β1(TGF-β1,10 ng/ml), basic fibroblast growth factor(bFGF,25 ng/ml) addexamethasone (DEX,10-7mol/L) with 15%FBS in DMEM. Cartilage slices wereobtained from femoral condyles and patellar grove in the same rabbit. The minced cartilage was digested in Ⅱ collagenase (3 mg/ml) to obtain chondrocytes(Group D). The change of cell appearance, proliferation capacity, glycosaminoglycans(GAG), immunohistochemical staining for type Ⅰ, Ⅱ collagen were observed during the 5th passage MSCs and MSCs after induction or gene modification. Expression of mRNA for type Ⅰ and Ⅱ collagen was detected by RT-PCR. Results Primary MSCs proliferated as shortspindle shape, while the 5th MSCs showed longspindle shape. Positive stain of type Ⅰ collagen could be found in groups A, B and C, while positivestain of type Ⅱ collagen was shown in groups B and D. The content of GAG in group B was higher than that in group A, but there was no significant difference between them（Pgt;0.05）, and there was significant difference between groups A and D（Plt;0.05）. No significant difference was noted in groups A,B and C on proliferation by MTT（Pgt;0.05）,except that of at the fourth day after transfection between groups A and C（Plt;0.05）. RT-PCR demonstrated that MSCs always had higher levelsof mRNA type Ⅰ collagen in groups A, B and C. The expression of mRNA type Ⅱ collagen was identified in groups B and D, and only low levels of mRNA type Ⅱ collagen in group C. Conclusion The above results indicate MSCs have a natural tendency of osteogenic differentiation in vitro culture, and also demonstrate the chondrogenic potency with the technique of cytokines induction or gene modification after passage. MSCs can be transfected efficiently being seed cells in tissue engineered bone or cartilage to accept target genes such as adHGF, and have a higher levels of expression in vitro, which lasted 4 weeks at least.