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.

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.

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: 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.

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

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.

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 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 discuss appropriate strategy about treatment of rotatory fixation or dislocation of atlantoaxial articulation in children. Methods 32 cases of rotatory fixation or dislocation of atlantoaxial articulation in children were analyzed retrospectively from January 2000 to March 2005, 24 males and 8 females; patients' age was from 3 to 12 years old with an average of 5.5 years old. The mean course of diseases was 6.5 weeks (range: 2 days to 50 weeks). According to Fielding-Hawkins clinical classification, typeⅠ17 cases(1 case with os odontoideum), type Ⅱ 12 cases(1 case with os odontoideum and 1 case with congenital absence of the arch of posterior atlas), type Ⅲ 3 cases. 26 cases received conservational treatments which were recommended as 2-3 weeks of cervical traction, traction weight should be controlled to 1.0-1.5 kg. After a successful reduction a proper external fixation was required to maintain reduction. And another 6 serious cases received posterior atlantoaxial or occipitocervical autograft fusion. Indications for posterior atlantoaxial or occipitocervical atuograft fusion includes: 1) have difficulty in reduction even under proper traction; 2) with obvious neurological symptoms; 3) combined with compensatory deformity of atlantoccipital articulation or other occiptocervical deformities. Results All of 32 cases were followed up from 3 to 50 months with an average of 32 months. 26 cases who received cervical traction and external fixation resulted in satisfactory outcome in which all the torticollis were rectified, bilateral masses were symmetrical on AP position, and ADI was less than 4 mm in dynamic extension and flexation lateral view. ROM in rotation and extension and flexion were completely recovered. All the 6 cases surgically treated obtained sound bony fusion and neural symptoms were improved obviously and torticollis were rectified completely in 4 cases and others (2 cases) stopped progressing after operation. Conclusion Conservative treatment including Glission traction, cranial traction, collar, cast or cervicothoracic external fixation has been proved to be very effective in most of rotatory fixation or dislocation of atlantoaxial articulation in children; however, operative treatment should be considered in the following situations: patients with difficulty in reduction, with neural involvement and compensatory deformity of atlantoccipital articulation or other occipitocervical deformities.

Objective To study the effect of TMB 8 on cerebral blood flow(CBF) of focal cerebral ischemia in the rats.Methods CBF in the middle cerebral artery occlusion after the middle cerebral artery occlusion was measured by a Laser Doppler Flowmeter. TMB 8 was administered 30 min before occlusion and 20 min after occlusion respectively.Results CBF was reduced quickly. TMB 8 0.5,1,2 mg/kg was administered 30 min before occlusion of the middle cerebral artery.The dosage inhibited the reduction of CBF,20 min after occlusion, CBF was increased by TMB 8 1 mg/kg significantly.Conclusion TMB 8 could prevent and treat the reduction of CBF in focal cerebral ischemia of MCAO in the rats,and improved the supply of blood in ischemic area.