Atlanto-axial complex is the most important functional unit of the cervical spine.Atlanto-axial instability or dislocation,one of the most serious pathologies in spinal surgery,is often managed by posterior atlantoaxial fixation and fusion.Several posterior fixation techniques have been used to stabilize the atlanto-axial complex,including wire/cable-bone fixation,Halifax clamps,transarticular screw fixation,screw-plate fixation and screw-rod fixation.For atlanto-axial dislocation that cannot be reduced with skull traction before operation,intraoperative reduction is often needed.Current intraoperative reduction techniques can be classified into transoropharyngeal surgical release followed by posterior reduction and fixation,transoropharyngeal reduction and fixation,and posterior reduction and fixation using screw-rod system according to approaches.Furthermore,posterior reduction can be performed using elevating-pull,leverages,and cantilever techniques.This study reviews the intraoperative reduction and fixation techniques mentioned above.

Bronchoalveolar lavage (BAL) was performed in healthy subjects (n = 12) and patients with bronchial asthma (n = ll). Between two groups there were no significant differences in total cells and percentage of alveolar macrophages (AM), lymphocytes, ncutrophils, cosinophils in BAL fluids. When AM were cultured in vitro and stimulated with dermatophagoides farinae(DPF) antigen, the quantity of PGE released by AM was significantly increased in asthmatics. When asthmatics' AM were sensitized with specific IgE positive serum and stimulated with DPF, they released more PGE, PGF2a than that when specific IgE negative serum was used (P

Articles about vertebral artery injuries secondary to blunt cervical spine trauma are increasing recently. The incidence of the disorder is reported from 19.4% to 46% in the literature. It has been found that unilate ral facet dislocations and bone fragments in the foraminal canal (comminuted fr acture of the foramen transversarium) have a significant association with the vertebral artery injuries,and that rotational violence may be a significant fac tor in causing vertebral artery occlusion. Patients with vertebral artery injuri es may have such symptoms as blurry vision, syncope, dysphagia and Wallenbergs syndrome. MRA(magnetic resonance angiography) is noninvasive and easy to per form at the time of initial MR. A routine evaluation of the extracranial circula tion with MRA should be performed as an additional sequence to all initial MR of the cervical spinal cord injury. Conventional angiography may be indicated only if the patient develops symptoms of cerebral ischemia. The benefit of antithrom botic therapy in reducing neurological morbidity and improving outcome has not y et been established and needs long-term follow-up. Operative management should be reserved only for patients with severe active bleeding or when interventiona l radiology fails. The surgical exposure is complex and demands excellent knowle dge of the local anatomy.

BACKGROUND: Upper cervical spine fractures are easy to lead to severe neurologic dysfunction in the elderly, and along with social progress, the incidence is on the rise. However, the diagnosis and treatment of type Ⅱ odontoid fractures in senile patients remain controversial.OBJECTIVE: To review the classification, treatment methods and clinical outcomes of type Ⅱ odontoid fractures in elderly patients.METHODS: A computer-based online search was performed in the PubMed and Wanfang databases for the articles concerning the diagnosis and treatment of type Ⅱ odontoid fractures in the elderly published from January 1996 to July 2016. The keywords were odontoid fracture, elderly, treatment, conservative, surgical in English and Chinese,respectively.RESULTS AND CONCLUSION: (1) The treatment goals of type Ⅱ odontoid fractures are different between elderly and young patients. (2) The incidence of nonunion in the conservative approach is higher than that in the surgical treatment, but for elderly patients, it makes no difference. (3) No significant differences are found in the incidence of complications and mortality between conservative and surgical methods in the elderly with type Ⅱ odontoid fractures. (4) Minimally invasive surgery is commended for the elderly suffering type Ⅱ fractures who cannot tolerate the conservative approach due to poor conditions or accompanied with other serious heart and lung diseases.

Ample evidences have showed that the failure of early regeneration of the central nervous system(CNS) in adult mammals is mainly due to the growth inhibitory factor.Efforts have been made to promote neuron regeneration and neurological function recovery by damaging myelin and removing myelin-associated inhibitors.At present,the Nogo protein associated drugs and gene therapy have become a novel effective way to promote axon regeneration after CNS injury;here we reviews the recent progress on the related issues.

BACKGROUND:Previous research has demonstrated human bone marrow mesenchymal stem cells(HMSCs)differentiate into hepatocyte-like cells;however,biological characteristics and differentiation mechanism remain unclear,and differentiation system remains immature.OBJECTIVE:To investigate the feasibility of hepatocyte growth factor(HGF)and epidermal growth factor(EGF)to induce the differentiation of HMSCs into hepatocyte-like cells.METHODS:HMSC5 were obtained from patients with esophageal cancer and were separated by density gradient centrifugation combined with attachment method.The phenotypes of MSCs were identified by flow cytometry.The third-passage HMSCs were divided into four groups:HGF(adding 20 μg/L HGF),EGF(adding 20 μg/L EGF),HGF+EGF,and blank control groups.Morphology was observed using inverted microscope.At days 7 and 14 after induction,α-fetoprotein and albumin mRNA expressions were detected using RT-PCR assay.RESULTS AND CONCLUSION:The HMSCs did not express hematopoietic cell CD34 and CD35,but strongly expressed β1-integrin CD29 and matrix receptor CD44.HMSCs changed from long fusiform shape to polygon or similar round shape in the HGF,EGF,and HGF+EGF groups.At days 7 and 14 after induction,α-fetoprotein and albumin mRNA expressions were positive.However,polygon cells were not observed in the blank control group,and α-fetoprotein and albumin mRNA expressions were negative.This suggested that HGF,EGF,and HGF+EGF could induce the differentiation of HMSCs into hepatocyte-like cells;however,their differentiation ability still needs to be further semi-quantitatively analyzed using immunohistochemical staining.

Objective:To investigate the molecular mechanism underlying apoptosis of lung adenocarcinoma cell line A549 induced by rapamycin, a type of mammalian target of rapamycin (mTOR) signal pathway inhibitor, combined with hypoxia treatment. Methods:Rapamycin was applied to treat A549 cell line under hypoxia for 16 h. Then the discrepancy of cell apoptosis between treated and untreated control was compared by Hochest 33258 staining. After being treated with rapamycin combined with hypoxia, the mRNA and protein expressions of survivin, a kind of anti-apoptotic molecule, were tested by real-time PCR and Western blotting. Western blotting was employed to test the difference of hypoxia-inducible factor (HIF)-1α expression level before and after rapamycin was added. In additon, chromatin immunoprecipitation(ChIP) assay was further applied to explore the mechanism underlying the effects of rapamycin under hypoxia in inducing apoptosis of A549 cells. Results:Rapamycin induced apoptosis of A549 cell line under hypxia in vitro. In A549 cell line, the expressions of survivin at mRNA (P<0.01) and protein levels, were both decreased by rapamycin combined with hypoxia treatment. Besides, ChIP assay revealed that rapamycin inhibited the expression of survivin at the transcriptional level through decreasing the hypoxia-induced up-regulation of HIF-1α and its binding with the promoter of survivin gene. Conclusion:Rapamycin exerted anti-tumor effects by inhibiting the expression of HIF-1α and decreasing the binding of HIF-1α with the promoter of survivin gene, thereby down-regulating the increase in the expression of apoptosis inhibiting gene survivin.

Objective To investigate the results of surgical treatment of atlantoaxial instability through posterior approach. Methods Seventy eight patients with atlantoaxial instability were used for this collective review, the patients included 38 with unstable odontoid fractures,15 with os odontoideum,8 with a disrupted transverse ligament, 6 with C1,2 tumor,6 with congenital occipitocervical abnormalities,5 with old Jefferson fractures. There were 57 males and 21 females. The mean age of the patients was 42 years(range, 3-78 years). All patients were treated by operation. Thirty seven patients were operated upon by atlantoaxial arthrodesis using wire fixation with autologous bone grafts. Nine were treated by C1,2 posterior wiring fixation and atlantoaxial facet screw fixation. Nine were operated on by atlantoaxial arthrodesis using Apofix interlaminar clamping with autologous bone grafts. Occipitocervical fusion was performed in 32 patients, arthrodesis simple with autologous bone grafts and external fixation was done in 11 patients. CD-Cervical fixation was used in 11 patients. Cervifix fixation was used in 10 patients. Results The patients were followed up for an average of 38.4 months(range, 6-216 months). Solid arthrodesis was obtained in 75 patients and non union in 3 cases. All the non union cases occurred after occipitocervical fusion. Conclusion Posterior fusion is recommended for atlantoaxial instability due to traumatic fracture or ligament disruption, tumor, inflammatory, skeletal dysplasias, congenital abnormalities. It is emphasized that adequately controlling atlantoaxial motion, meticulously preparing the fusion bed are the important measures for successful operation.

[Objective]To explore the value of anterior approach in the surgical treatment of cervical fracture and dislocation.[Method]Thirty cases of lower cervical fractures and dislocations were treated with anterior decompression,reduction,autograft and plate fixation or titanic net.[Result]Patients were followed up for 6 to 24 months,the regular X-ray film to observe the stability of segmental injury and the Frankel grade to determine the recovery of the spinal cord were recorded.All cases were improved and obtained solid fusion within 3～5 months.The intervertebral heights and physiologic curves were kept well,without plate or screw complications occurring in these cases.[Conclusion]It is feasible to get complete decompression,good reduction and excellent maintenance of intervertebral heights and physiologic curves by employing anterior approach to treat lower cervical fractures and dislocations.More importantly,it can get immediate stabilization to cervical spine and prevent secondary injury to spinal cord and recover nervous function.

[Objective]To evaluate the outcomes of treating thoracolumbar burst fractures in young adults with posterior short-segment pedicle screw fixation without fusion by analyzing the clinical and radiographic parameters.[Method]Fifty-four patients with thoracolumbar burst fractures from June 2002 to April 2006 were investigated retrospectively.Thirty-one patients were male and 23 were female.The mean age was 31 years.All patients underwent open reduction and posterior short-segment pedicle screw fixation without bone graft fusion,and had their implants removed at 12 to 20 months post-operatively.Pain status was evaluated using the visual analog scale(VAS).Changes in the anterior vertebral height ratio,Cobb′s angle,and vertebral wedge angle were measured preoperatively,postoperatively,before implant removal,and at 2 years after implant removal.[Result]Thirty-two patients were available to follow-up,with an average period of 43 months(range,36-56 months).A good correction was gained and pain was released significantly after surgery.The loss of correction was statistically significant and there were 4 patients suffering from screw broken before the instrumentation removal,however.A progressive kyphotic deformity (Cobb′s angle increased while vertebral wedge angle unchanged) was caused by the collapse of the intervertebral disc space while the reduced vertebral height was stable after the implant removal.No significant correlation was found between the final kyphosis and pain scale.[Conclusion]Short-segment pedicle screw fixation without fusion can provide good reduction and sustained corrective height if adequat indication of thoracolumbar burst fractures has been choosen.Earlier implant removal can regain local segmental motion.