Objective To explore the changes of bone mineral density (BMD) and bone markers in senile osteoporosis patients treated with teriparatide,and evaluate the improvement on quality of life (QOL) as well as the clinical significance.Methods Forty-five senile osteoporosis inpatients were treated with 20 μg of teriparatide for one year.BMD and bone markers were detected before treatment and also in the third,sixth and twelfth month during treatment.The level of numerical rating scale (NRS) and QOL were assessed.Results The NRS before treatment was (4.96±2.25) , and those after treatment of 3, 6 and 12 months were(2.84±1.41), (1.56±1.16) and (1.36±1.00), respectively (P<0.01).The total scores of SF-36 significantly increased after treatment (P<0.01).After treatment of 3, 6 and 12 months, BMD of lumbar vertebra had increased 7.7%, 12.3% and 15.4%, respectively;that of femoral neck had increased 3.0%, 6.1% and 7.6%, respectively;and that of intertrochanteric bone had increased 5.7%, 8.6% and 10.0%, respectively.Meanwhile, the serum levels of osteocalcin, bone alkaline phosphatase and N terminal propeptide of type I procollagen were significantly higher than those before treatment (P<0.01), nevertheless beta collagen cross-linked C-terminal peptide (β-CTX) only significantly decreased at the 12th month after treatment (P<0.05).Conclusion Chronic teriparatide therapy could significantly relieve bone pain,improve the quality of life and increase lumbar vertebra BMD in senile osteoporosis.

Objective To investigate the feasibility of percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. Methods One patient with thoracic disc herniation involved the level of vertebral segment in T11/12 was treated with percutaneous transforaminal endoscopic spine system and followed up for 1 month. The targeted puncture was performed under local anesthesia and fluoroscopic guidance with patient in prone position. The foramen of T 11/12 was enlarged gradually with four trephinations, and the working cannula was inserted transforaminal into the canal. Then the herniation was exposed and removed with full endoscopic technique, including the loosen nucleus pulposus. The dural sac was exposed and released adequately. Drainage was placed during operation. Results The procedure was successfully carried out and the dural sac was completely released. The drainage was removed in the second day of operation. The patient could walk in the third day after operation with obvious relief of back and leg pain. At the follow-up of one month postoperation, the visual analogue scale of leg pain decreased from 8 to 1, and the Oswestry disability index (ODI) decreased from 64 to 4. According to MacNab scale, excellent result was acquired. Conclusion There is the feasibility of the percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. It is a good minimal invasive technique with good results and high technical requirements for surgeons.

AIM: To explore the effects of hydrogen sulfide (H_2S) on proliferation of vascular smooth muscle cells (VSMC) stimulated by endothelin (ET-1, 10 -7 mol/L ) and mitrogen-activated protein kinase (MAPK) activity in VSMCs. METHODS: Cultured VSMCs were divided into six groups: (1) control group, (2) serum group, (3) endothelin group, (4) NaHS groups, (5) serum+NaHS group, and (6) endothelin+NaHS group. VSMC proliferation was measured by [ 3H]-TdR incorporation and MAPK activity in VSMC was determined by radioactivity assay. RESULTS: ET-1 increased VSMC [ 3H]-TdR incorporation by 2.39 times ( P

AIM: The activity and expression of neutral endopeptidase (NEP) and the adrenomedullin (ADM) contents in various tissues were observed in septic shock and control rats to study the possible role of NEP in the change of ADM contents in tissues during septic shock. METHODS: The septic shock model of rats were established by cecal ligation and puncture (CLP). ADM contents, NEP activities, level of NEP mRNA and NEP protein were measured. RESULTS: (1) In early septic shock (ES), the ADM contents were generally higher in detected tissues, the NEP activity in left ventricle and small intestine were lower and was higher in blood than those in controls, and in lung, kidney and aorta were similar with the controls. NEP immunoreactive staining were less in lung, left ventricle, endothelium and media of aorta, but more in adventitia of aorta and kidney than those of the controls; (2) In late septic shock (LS), the ADM contents in small intestine was less but in plasma and other tissues were higher, and the NEP activity were less in plasma and other tissues than those in ES. The NEP immunoreactive staining were less in heart, endothelium and media of aorta, lung and kidney than those in ES, and was no significant change in adventitia of aorta compared with those of ES. RT-PCR found that NEP gene expression were significantly less in left ventricle, aortas, lung and small intestine than those in the controls. CONCLUSIONS: In septic shock rats, the NEP activity changes heterogeneously but the ADM contents elevate in most tissues. These results indicate that during the septic shock, the local concentrations and actions of ADM in various tissues may be regulated differently by the NEP. [

Objective To analyze the value of mini-open approach beside costodiaphragmatic recess in thoracolumbar spine surgery. Methods This approach was applied in 31 anterior thoracolumbar spine surgeries, including 22 men and 9 women, with a mean age of 41 years old (range, 26-58 yrs). The diagnosis were burst fractures in 27 cases (T12 level in 12 cas?es and L1 level in 15 cases) and disc herniations with osteochondrosis in 4 cases. An antero-lateral 10-15 (average is 12) cm incision was performed, then the 11th rib was resected and the extraperitoneal space below diaphragma was disconnected. The pleura fold was identified beneath the rib bed, so the gap beside the costdiaphragmatic recess was entered through an in?cision beyond the fold. The diaphragm and medial arcuate ligament were clipped and vertebral body from T11 to L2 were ex?posed. Results The lateral side of T11 to L2 vertebral body was sufficiently exposed in all the 31 patients. In 26 patients, the pleura fold was beyond the bed of the 11th rib, so the 11th intercostals vessel and nerve were exposed and protected, and the costodiaphragmatic recess was reached through the superior border of the 12th rib. Laceration of pleura occurred in 4 cases af?ter it was sutured, but the extra-pleura approach could still be used after repairing without invading into thorax. Fixation and fusion were performed from T11 to L2. Complications include intercostals nerve pain were seen in 3 cases, which resolved with conservative treatment. Conclusion The mini-open approach beside costodiaphragmatic recess can be used in anterior thoraclumbar spine surgery with sufficient explosion and minimum injury in which thoracic cavity.

Objective To investigate the effect of anterior percutaneous endoscopic discectomy (APECD) and open-door laminoplasty (ODLP) through hybrid surgery in the treatment of multisegmental cervical stenosis and giant disc herniation. Methods This study involved 3 patients with multisegmental cervical stenosis and giant disc herniation confirmed by MRI. Among them, there were 2 males and 1 female, with ages from 56-61. All patients showed significant paresthesia or weakness, and were treated between September and November 2016. The surgery was performed by first the ODLP that made spinal cord back shift, and then APECD for the second step. The visual analog scale (VAS) and neck disability index (NDI) were assessed before and after operation. Results The VAS and NDI scores were improved two weeks after operation. No adverse events like spinal cord injury and vascular injury were found during the operation. After operation, no patients were found incision infection, hematoma formation, cerebrospinal fluid leakage, dysphagia, trachyphonia and so on. Conclusion The hybrid surgery of APECD and ODLP for the treatment of the multisegmental cervical stenosis and giant disc herniation can not only decompress the nerve safely and improve the function, but also preserve cervical intervertebral disc and motion segments, therefore delaying the degeneration of adjacent segments with clinical significance.

Objective To evaluate the clinical efficacy of treatment of severe thoracolumbar burst fractures by posterior short-segment instrumentation without spinal fusion and assess radiographic imaging and function recovery after surgery.Methods Thirty-eight patients with severe monosegmental thoracolumbar burst fractures treated between July 2011 and March 2013 were analyzed retrospectively.Operation procedures were posterior short-segment pedicle screw distraction reduction and fixation combined with screw insertion to the injured vertebrae and calcium sulphate augmentation.In addition,there was no need for posterolateral interbody fusion.X-ray and CT were performed before and after operation to evaluate local kyphotic angle,anterior fractured vertebral body height and canal encroachment.Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before and after operation as well as in follow-up.Results All patients were followed up for average 14 months (range,3-20 months).Local kyphotic angle was (21.2 ±4.3)° before operation,(3.5 ± 1.8)°immediately after operation,and (4.8 ± 2.7) ° in final follow-up.Relative anterior vertebral height was (54.8 ± 14.6)％ before operation,(91.7 ± 8.0)％ after operation,and (87.2 ± 6.0)％ in final follow-up.Mean canal encroachment was (48.0 ± 4.5)％ preoperatively,(23.8 ± 7.8)％postoperatively,and (8.8 ± 4.6) ％ in final follow-up.In final follow-up,six patients with American Spinal Injury Association (ASIA) grade C on admission showed improvement to grade D (n =2) and grade E (n =4) ; 10 patients with ASIA grade E on admission showed improvement to grade E; 22 patients with grade E had no changes.ODI and VAS scored 15.5 ±8.8 and 2.3 ±0.8 in final follow-up with substantial improvement from those before operation (P ＜ 0.01).Complications from internal fixation were not found during follow-up.Conclusion Posterior short-segment fixation without fusion is one of the foremost effective methods for severe thoracolumbar burst fractures,for it can effectively restore the sagittal spinal alignment and the fractured vertebral body height.

Objective To evaluate the efficacy and safety of sirolimus and tacrolimus after renal transplantation.Method PubMed,Web of knowledge,Medline and the Cochrane Library were searched with the terms and Boolean operators as (kidney transplantation OR renal transplantation) AND (sirolimus OR rapamycin) AND (tacrclimus OR FKS06).Results retrieved were last updated on June 9,2014.Language limit of English and Chinese only was applied.Trials were excluded if enrolling recipients of organs other than kidneys,reporting none of the outcomes in point or combining sirolimus with tacrolimus.Patient and graft survival,acute rejection and adverse events were evaluated as primary outcomes and glomerular filtration rate (GFR) was an additional surrogate for renal function.Professional meta-analysis software RevMan 5.1 was employed to analyze the pooled risk ratio (RR) and mean difference (M D) followed by subgroup analysis and sensitivity analysis.Result Fifteen studies were included with 2480 patients.Patients in the sirolimus group showed an increased rate of acute rejection within one-year's follow-up 2.02 (95％ CI 1.37-2.99,P＜0.05) and also a higher risk of adverse events 1.31 (95％ CI 1.02-1.68,P＜0.05).The incidence of hyperlipidaemia was significantly higher with RR =1.75 (95％ CI 1.17-2.61,P＜ 0.01) in the sirolimus group.The other outcomes were insignificantly different between two groups.In subgroups with ATG as immunity induction and higher sirolimus concentration (＞4-8 μg/L),the difference was insignificant (P ＞ 0.05).Conclusion This meta-analysis concluded that sirolimus showed no advantage over tacrolimus when used early after transplantation.When used with higher concentrations,or with ATG as immunity induction,the disadvantages may be avoided.More clinical evidence is needed.

Objective To evaluate the feasibility and clinical efficacy of microendoscopic discectomy-lumbar interbody fusion (MED-LIF) with mobile microendoscopic discectomy (MMED) technique. Methods The MMED includes outer working canal and inner operating canal, and large working canals (12 mm and 14 mm) are fabricated for this operation. The operation was designed as follow:an incision was made between pedicle projection sites and spinous process on the side with prominent symptom. Working canal was inserted along spinous process and a fenestration was performed. After discectomy and ipsilateral decompression, contralateral nerve was decompressed in case of contralateral stenosis. Then the intervertebral space was prepared and grafted. The inner operating canal was removed and the suitable cage was inserted, followed by percutaneous pedicles screws installation, reduction and fixation. A total of 102 patients with lumbar degenerative disc disease were treated by this technique. The index levels included L34 (n=11), L45 (n=64), L5S1 (n=21), L3-5 (n=3), and L4-S1(n=3). The operative data and follow-up results were recorded and evaluated. Results Surgery was successful in all patients, with no nerve injury or conversion to open surgery. The mean operative time was ( 120 ± 30) min (range, 90-200 min), with a mean blood loss of (120 ± 80) mL (range, 50-300 mL). The post-operative X-ray and CT scans showed improvement of spinal alignment with sufficient decompression. Patients were followed up for 6 to 36 months. The Oswestry disability index (ODI) score decreased from the pre-operative 44.2%±16.3%to the last follow-up 4.9%±4.7%. The visual analog pain score (VAS) of lumbar decreased from the pre-operative 5.3±4.1 to the last follow-up 2.1±1.7, and VAS of leg decreased from the pre-operative 6.7 ± 3.5 to 1.0 ± 0.8 at final follow-up. The clinical results were excellent in 46 cases, good in 50 cases and fair in 6 cases according to the Macnab standard. Conclusion MED-LIF can be easily performed with MMED technique, with sufficient decompression and reduction, providing satisfactory results with less invasive procedure.

Objective To evaluate the feasibility and clinical efficacy of microendoscopic discectomy-transforaminal lumbar interbody fusion (MED-TLIF) with mobile microendoscopic discectomy (MMED) technique. Methods The MMED includes outer working canal and inner operating canal. Large working canals and endoscopic chisel were fabricated for MMED-TLIF,which was designed as follow:the pedicles and index level were located with fluoroscopy, and a 2.5 cm incision was made between pedicle punctures sites on the symptomatic side. Working canal was inserted, and the facet was exposed,the inferior articular process and medial part of superior articular process were resected. The disc and cartilage endplates were curettage, and the intervertebral space was released and tested. The inner operating canal was removed and the interbody space was grafted and supported with suitable cage. Percutaneous pedicles screws were inserted and the residual displacement was evaluated under fluoroscopy, followed by the install of connecting rods for reduction and fixation. Fifty-six patients with lumbar stenosis including 32 cases of instability and spondylolisthesis (1 degree in 15 cases and 2 degree in 9 cases) were treated with this technique. The ODI index and VAS score were compared in patients before and after surgery. The efficacy was evaluated by Macnab standard. Results Surgery was successful in all patients, with no nerve injury or conversion to open surgery. The mean operative time was (120±30) min (range, 90–180 min),with a mean blood loss of (120±50) mL (range,50–200 mL). The post-operative X-ray and CT scans showed improvement of spinal alignment with mean reduction ratio of 72%. Patients were followed up for 6 to 36 months. The ODI score decreased from 50.1±11.2 to 5.8±5.6. The VAS score of lumbar decreased from 7.1±4.2 to 1.2±1.0 and VAS score of leg decreased from 4.1±2.5 to 1.1±0.9 at final follow-up. The clinical results were excellent in 36 cases,good in 20 according to the Macnab scale. Conclusion MED-TLIF can easily perform with MMED technique,with sufficient decompression and reduction, and providing satisfactory results with less invasive procedure.