Objective:To investigate the surgical outcome of one-stage combined anterior and posterior ap-proach for severe thoracolumbar and lumbar spine fracture.Method:A total of 62 cases suffered from severe thoracolumbar and lumbar spine fracture undergoing surgery from Jan 2003 to Jan 2008 were reviewed retro-spectively.Of these,there were T11 involved in 2 cases,T12 in 13 cases,L1 in 28 cases,L2 in 10 cases,L3 in 6 cases and L4 in 3 cases.There were 58 fresh fractures and 4 old fractures.Based on Dennis classifica-tion,12 were compression fracture,33 were burst fracture and 17 fracture dislocation.All cases had spine load score≥7 and TLICS score≥5.Of 19 cases with neurological deficit according to Frankel grade,there were 7 A,5 B and 7 C.Combined anterior and posterior approach was performed in all cases,anterior bony graft plus posterior pedicle instrumentation were performed either,of these,52 cases had additional anterior decompres-sion.Result:All operations were performed successfully,with the mean surgical time of 170min (range, 150-210min) ,the average blood loss was 819ml(range,400-2900ml).No iatrogenic neuroinjury,skin infection, dural matter tearing and graft displacement were noted.The preoperative Cobb's angle was 8°-40°(mean, 23.9°), while the postoperative counterpart returning to normal with 5 cases having 2°-10° kyphosis.The preoperative compression rate was 20%-95%(mean,54.5%),while the postoperative counterpart returning to normal in 47 cases,with 15 cases having 2%-30%.The preoperative canal stenosis rate was 5%-90%(mean,51.1%) while the postoperative counterpart was 0-30%(mean,4.7%),which showed significant difference with regarding to these 3 parameters (P<0.05).All cases were followed up for an average of 31 months (range,12-72 months). Bony fusion was evidenced in cases undergoing anterior bony graft.At 10-12 months, the Cobb's angle was 0°-15°(mean,0.62°) ,the vertebral compression rate was 0-30%(mean,4.6%),no significant difference were noted between them and their postoperative counterparts(P>0.05).At final foUow-up,15 of 19 cases with neu-rological deficit had neurofunction improved,while 4 remained unchanged.According to our hospital criteria,of 43 cases with no neurological deficit,there were 30 excellent,9 good,3 fair and 1 bad with the total excel-lent to good rate of 90.6%.Cage subsidence and pedicle screw breaking was noted in 1 case,who developed severe kyphosis presenting with irreducible back pain.Conclusion:One-stage combined anterior and posterior approach for severe thoracolumbar and lumbar spine fracture can ensure three column stability as well as complete decompression,which has good early outcome.

Objective To investigate the complex effect of soman and hypoxia on PC12 cell line as shown by the expression changes in IL-6/GP130, JAK1 and STAT1. Methods A cell model of intoxication by combining effect of hypoxia and soman was reproduced, and it was divided into four groups: control, soman intoxication, hypoxia combined with soman intoxication, and Genistein inhibition groups. PC12 cells were cultured in RPMI 1640 and were treated with NGF (50ng/ml) for seven days. The differentiated PC12 cells were then exposed to hypoxia in an incubator containing 5% CO2, 95% N2 and (or) incubated with soman (20?mol/L) for 2, 6, 12 or 24 hours. The expression levels of IL-6/GP130, JAK1, STAT1 mRNA and protein were assessed by RT-PCR and Western blot in PC12 cells. The products were sequenced by Sanger's double strand DNA sequence determination. Results In soman intoxicated group, the expression levels of IL-6/GP130, JAK1, STAT1 mRNA and protein were elevated in PC12 cell, reaching the peak level at 12 hours, and then lowered at 24 hours, but remaining higher than that of control group. In combined soman intoxicated and hypoxia group, the expression levels of IL-6/GP130, JAK1, STAT1 mRNA and protein reached the peak value at 6 hours, being higher than that of control group, soman intoxicated group and Genistein inhibition group. It was shown that the sequences of the products as amplified by RT-PCR were the same as that found in the GenBank. Conclusion Soman intoxication or (and) hypoxia up-regulate the expression of IL-6/GP130. Both hypoxic condition and soman treatment can up-regulate the expression of JAK1/STAT1 mRNA and protein in PC12 cells. JAK-STAT pathway may play a role in the mechanisms of brain injury resulted from hypoxia and soman poisoning.

Objective To explore the effects of oxidative stress and pulmonary vascular permeability on lung injury in rats treated with sodium cyanide(NaCN) and /or hypobaric hypoxia.Methods A total of 72 male SD rats were randomly divided into 2 groups: the NaCN intoxicated group in 308m altitude and the hypobaric hypoxia combined NaCN intoxicated group in 4 000m high altitude.The animals for the experiment of hypoxia were processed in an artificial hypobaric chamber to simulate the designated high altitude hypoxia(4 000m,61kPa).NaCN was injected subcutaneously to the rats in the both groups at the dosage of 3.6mg/kg.Broncho-alveolar lavage fluid(BALF) and lung tissues were prepared at the time points of 0,0.5,1.0,2.0,4.0 and 6.0h.The activity of SOD,GSH-PX,ACE,LDH,AKP and the content of MDA,GSH,Evan's blue(EB) were detected by spectrophotometric method.Results Combined acute hypobaric hypoxia and NaCN intoxication produced a significant increasing effect on EB content in the rats.The activity of ACE,LDH and AKP in BALF,and the contents of MDA in BALF and lung tissue reached the highest value at 0.5h preparation at the combined hypobaric hypoxia and NaCN intoxicated group,but they were still higher than that of control group(NaCN intoxicated only);correspondingly the activity of SOD,GSH-PX,content of GSH in lung tissue and BALF reached the lowest value at 0.5h preparation at the combined hypobaric hypoxia and NaCN intoxicated group,but they were still lower than that of control NaCN intoxicated group.Conclusion The results suggest that under the condition of hypoxia,NaCN intoxication may produce severe harmful effects on the lungs,increase the pulmonary vascular permeability,and cause severe interference on to the oxidative stress level.

Three cases of lower lumbar nerve root gangliomas with spinal instability or lumbar disc herniation are reported. The first patient was treated for lumbosacral pain and discomfort for more than 10 days. Preoperative diagnosis was L 5S 1 intervertebral instability, L 5 bilateral spondylolysis, and L 5S 1 left intervertebral foraminal space occupying lesions to be investigated, the tumor was removed intraoperatively and sent to pathology. Meanwhile, L 5S 1 posterior interbody bone graft fusion and internal fixation were performed. The second patient presented for 1 month due to left lumbar and leg pain and discomfort. Preoperative diagnosis was L 4-5 intervertebral instability and L 4-5 intervertebral disc herniation. Intraoperative exploration revealed a nerve root mass on the left side of L 5, which was surgically removed and sent to pathology. Meanwhile, posterior decompression of L 4 and L 5 intervertebral bone grafting and internal fixation were performed. The third patient presented for 4 days with right lumbar and leg pain and discomfort. Preoperative diagnosis was L 3-4, L 4-5 and L 5S 1 intervertebral disc herniation. Intraoperative exploration found a right nerve root mass of S 1, which showed invasive growth and was closely surrounded by nerve fibers. Partial resection of the mass was sent to pathology, and posterior decompression and internal fixation of L 4-5 and L 5S 1 bone grafting and fusion were performed at the same time. All 3 patients were confirmed to be ganglion neuroma by postoperative pathological examination. Three patients recovered well after surgery. Spinal ganglion cell tumor is mainly originated from primitive neural crest cell migration differentiation of sympathetic ganglion cells, and can also be derived from the sympathetic nerve and peripheral nerves. It is seen more at retroperitoneal and mediastinal, lumbosacral nerve root ganglion cells tumor is rare. Clinically, it is very close to intervertebral disc herniation and difficult to distinguish, often found during operations and less can be clearly diagnosed before operation. Surgical resection is the main treatment for ganglion cell neuroma.

Objective To evaluate the clinical value of a new optic puncture needle designed by our department for renal calculi treatment. Methods There were 8 patients undergoing micro-PCNL with the new device from June 2016 to February 2017. Values of basic demographic data ,operation time ,pain score ,drop in hemoglobin and complications were recorded. Results The mean stone size,operation time,pain score,drop in hemoglobin,and in-hospital time was(21.9 ± 7.3)mm,(43.6 ± 13.6)min,2.8 ± 1.3,7.0 g/L[(133.2 ± 10.3 g/L vs.(123.2 ± 13.9)g/L,P>0.05]and(3.1 ± 1.0)d,respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months post-operation were 87.5%(7/8)and 100%(8/8),respectively. One suffered urinary tract infections( ClavienⅠ)and was treated with antibiotics. There were no major complications. Conclusion The new device for treatment of renal calculi is feasible and effective.

Objective:To investigate the clinical features of diagnosis and treatment of renal parenchymal invasive urothelial carcinoma.Methods:The clinical data of 23 patients with renal parenchymal invasive urothelial carcinoma admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2014 to December 2020 were retrospectively analyzed. There were 12 males and 11 females. The mean age was (67.3±10.1) years old. Among them, 7 cases complained of painless hematuria and 9 cases were asymptomatic. Three cases underwent preoperative MRI examination, 19 patients underwent preoperative enhanced CT examination, and 1 patient underwent both MRI and enhanced CT examination. MRI examination showed renal lobulated and other T1 mixed with T2 signals, the boundary was not clear, and DWI showed obvious restricted diffusion. The tumor was located on the left side in 15 cases and on the right side in 8 cases. Preoperative diagnosis was made by fine needle aspiration biopsy in 1 patient, and specimens were obtained by flexible ureteroscope in 2 patients. No tumor was reported. The preoperative diagnosis of 22 patients was unclear and the nature of the tumor could not be determined. One patient was considered to have urothelial carcinoma by fine needle aspiration. All patients were treated by surgery, including 20 cases of laparoscopic radical nephrectomy and 3 cases of nephroureterectomy with bladder sleeve resection.Results:Postoperative pathological specimens showed yellow-white mass, high-grade invasive urothelial carcinoma invading renal parenchyma. Nine cases were T 3a stage, 14 cases were T 3b stage, and 5 cases were lymph node metastasis. The average postoperative follow-up time was (18.6±6.72)months, 2 patients were lost to follow-up, 8 patients died, and the overall mortality rate was 38.1%. Seven patients died of recurrence or metastasis. There were 3 cases of bladder recurrence and 5 cases of metastasis after operation. Conclusions:Renal parenchymal infiltrating urothelial carcinoma is difficult to diagnose in the early stage, with poor clinical biological behavior and poor overall prognosis. For patients diagnosed with renal parenchymal invasive urothelial carcinoma preoperatively, laparoscopic nephroureterectomy + bladder sleeve resection is recommended.