Objective To discuss the operative efficacy of anterior- and postero-decompression plus pedicle screw instrumentation through posterior approach in the treatment of thoracolumbar burst fractures. MethodsFrom February 2006 to November 2009,28 patients with thoracolumbar burst fracture and spinal cord injury were treated with anterior-and postero-decompression plus pedicle screw instrumenattion through posterior approach.They were 19 men and 9 women,21 to 52 years of age (average,35.6 years).The fractures happened at T11 in 3 cases,at T12 in 11 cases,at L1 in 9 cases and at L2 in 5 cases.By AO classification,there were 16 cases of type A3,7 cases of type B and 5 cases of type C.By the ASIA(American Spinal Injury Association) system,6 cases were rated as grade A,12 cases as grade B and 10 cases as grade C. Bone grafting was performed according to different conditions of the patients.Results The patients were followed for 12 months to 24 months,with an average of 14 months.The X-ray examinations showed that the mean anterior border height of the injured vertebrae recovered from46.8％ ± 18.3％ of the normal height before operation to 90.3％ ± 14.2％ postoperatively; the mean posterior border height recovered from preoperative 80.4％ ± 12.4％ to postoperative 94.2％ ± 15.1％ ; and the mean cobb angle decreased from preoperative 20.1°± 11.5° to postoperative 2.7°± 2.4°. The differences between preoperation and postoperation were significant(P ＜ 0.05).According to the ASIA evaluation system,neurofunctional recovery was achieved in the cases of incomplete paralysis except in the 6 eases who had had complete spinal cord injury of Grade A. Conclusion Anterior- and posterro-decompression plus pediclescrew instrumentation through posterior approach is an effective method of treating thoracolumbar burst fractures.

Purpose To investigate the expression of programmed death ligand-1 (PD-L1) in breast cancer tumor cells and stromal tumor-infiltrating lymphocyte (sTIL),and to study the relationship between the expression of PD-L1 and the clinicopathological characteristics of the patients.Method The protein expression of PD-L1 was detected by immunohistochemistry of EliVision two-step method in 68 cases of non special type of invasive breast cancer,and the relationship between the expression of PD-L1 protein and the immunohistochemistry subtypes and clinical parameters was analyzed.Results The total expression rate of PD-L1 was 35.3％ in breast tumor tissue,specially in triple negative breast cancer (TNBC) which occupy the highest positive rate.The expression rates of PD-L1 in tumor tissue of the luminal subtype,HER-2 over-expression subtype and TNBC subtype were 16.1％,37.5％ and 61.9％ respectively,and the difference was statistically significant.The total expression rate of PD-L1 in sTIL was 51.5％,and the highest expression rate was 81.0％ in TNBC.There were significant differences of PD-L1 expression in sTIL of the luminal subtype,HER-2 over-expression subtype and TNBC subtype.Expression of PD-L1 in tumor tissue and sTIL had a significant positive correlation.Conclusion PD-L1 expressed in TNBC was significantly higher than other types of breast cancer,which suggest the blocking of signal pathway of PD-1/PD-L1 may expected to become a new immunotherapy for breast cancer,especially for TNBC subtype.

Objective To study the correlation between morphological characteristics of coronary artery calcified plaques and luminal stenosis of local coronary artery segments with 64-slice computed tomography.Methods One hundred and eleven patients who had undergone 64-slice computed tomographic coronary angiography(CTCA)and conventional coronary angiography(CAG)were retrospectively analyzed.The calcified plaques were classified as punctate,nodular,strip-like and nubbly in long-axis view of coronary artery lumen,and were classified as crescent,semilunar,round moon and circinate in short-axis view.The morphologic characteristics of these calcified plaques on CTCA were retrospectively analyzed and compared with luminal stenosis of CAG results.Results Among 528 calcified coronary segments which were analyzed in 111 patients,there were 383(72.5%)punctate calcified plaque segments and 145(27.5%)of non-punctate plaques.There were 34(23.4%,34/145)non-punctate calcified plaques which caused severe stenosis(≥75%),including 4(11.8%)nodular,8(23.5%)stripe-like and 22(64.7%)nubbly calcified plaques on the long-axis view,and 0(0.0%)cresent,8(23.5%)semilunar,18(52.9%)round moon and 8(23.5%)circinate calcified plaques on the short-axis view.The ratios of different morphological coronary artery calcifications which caused severe stenoses were significantly different with each other(all P＜0.01).Conclusion Different figures of coronary artery calcified plaques demonstrate different degrees of stenoses of local coronary artery lumen.Severe stenoses were mostly caused by nubbly calcified plaque on long-axis view,round moon and circinate calcified plaque on short-axis view.

Objective To investigate the intra- and interobserver repeatability of coronary artery disease (CAD) diagnosis based on invasive coronary angiography (ICA) and CT coronary angiography (CTCA).Methods Two readers with comparable experience ( over 10 years) independently evaluated ICA results of 42 consecutive patients with a blind method. After 30 days,one of them reviewed the same patients again.Another two comparable-experience (over 10 years) readers evaluated the results of CTCA (prospectively ECG-triggering) from the same 42 patients in the same way.The inter-reader and intra-reader repeatability of ICA and CTCA were analyzed by performing Kappa test and calculating the percentage of the segments with agreement on stenotic degree.Using ICA as reference,the accuracy of CTCA in diagnosing CAD was studied by comparing the area under ROC. Results The Kappa between readers for ICA and CTCA were 0.91 and 0.81.Intra-reader Kappa were 0.92 and 0.83 respectively (x2 =509.4 and 432.5,all P ＜0.01 ).The percentage of the segments with agreement between readers on the degree of stenosis were 80.8％ (494/611) in ICA and 75.2％ (469/624) in CTCA ( x2 =2.75,P =0.10),and within the same reader,86.9％ (531/611)in ICA and 81.9％ (511/624) in CTCA(x2 =3.76,P =0.053).With≥ 50％narrowing as a CAD diagnosis criterion,the agreement rates for two readers were 96.6％ (590/611 ) in ICA and 94.4％ (589/624) in CTCA( x2 =3.36,P =0.07),and for the same reader,97.4％ (595/611) in ICA,95.4％ (595/624) in CTCA ( x2 =3.62,P =0.06).Using ICA as reference,two readers of CTCA results achieved a sensitivity and specificity of 84.9％ (530/624)and 98.1％ (612/624).The area under ROC was 0.94 (95％ CI 0.91-0.97).Conclusions Both ICA and CTCA demonstrate good repeatability in diagnosing CAD.The repeatability of ICA is superior to that of CTCA.A certain discrepancy exists in two readings from the same reader or two readers.

Psoraleae Fructus (PF) is a well-known traditional herbal medicine in China, and it is widely used for osteoporosis, vitiligo, and other diseases in clinical settings. However, liver injury caused by PF and its preparations has been frequently reported in recent years. Our previous studies have demonstrated that PF could cause idiosyncratic drug-induced liver injury (IDILI), but the mechanism underlying its hepatotoxicity remains unclear. This paper reports that bavachin isolated from PF enhances the specific stimuli-induced activation of the NLRP3 inflammasome and leads to hepatotoxicity. Bavachin boosts the secretion of IL-1β and caspase-1 caused by ATP or nigericin but not those induced by poly(I:C), monosodium urate crystal, or intracellular lipopolysaccharide. Bavachin does not affect AIM2 or NLRC4 inflammasome activation. Mechanistically, bavachin specifically increases the production of nigericin-induced mitochondrial reactive oxygen species among the most important upstream events in the activation of the NLRP3 inflammasome. Bavachin increases the levels of aspartate transaminase and alanine aminotransferase in serum and hepatocyte injury accompanied by the secretion of IL-1β via a mouse model of lipopolysaccharide-mediated susceptibility to IDILI. These results suggest that bavachin specifically enhances the ATP- or nigericin-induced activation of the NLRP3 inflammasome. Bavachin also potentially contributes to PF-induced idiosyncratic hepatotoxicity. Moreover, bavachin and PF should be evaded among patients with diseases linked to the ATP- or nigericin-mediated activation of the NLRP3 inflammasome, which may be a dangerous factor for liver injury.
Adenosine Triphosphate ; Animals ; Chemical and Drug Induced Liver Injury/etiology* ; Flavonoids ; Humans ; Inflammasomes ; Mice ; NLR Family, Pyrin Domain-Containing 3 Protein ; Nigericin