Objective To analyze the effect of cigarette smoking on replantation of amputed digit, investigate the pathologic mechanism of vascular crisis(VC) caused by smoking. Methods 1)The replantation risk factor such as smoking to VC and blood insufficiency of replanted digit was reviewed in 1 685 cases of digit replantation. 2)The complications after digit replantation in short and long terms among patients smoking were compared with those not smoking after operation. The results of management and time of appearance VC was assayed. 3)The possible pathologic mechanism of VC caused by smoking was analyzed. Results 1)A significant correlation between the ratio of VC, blood insufficiency of replanted digit and smoking index(SI, the number of cigarette in a day multiplies the years of smoking) was found. 2)The rate of VC, wound infection and unhealing in short term and the feeling of pain, numbness and cool in the long term in patients smoking after operation (92.6%,55.6%,48.1% and 71.6%) was obviously more than that in non smoking patients(17.8%,9.3%,2.0% and 3.0%,P

Objective To investigate the characteristics and the effect of severed hallux replantation.Methods Eighteen completely severed halluces had been replanted since 1991.Injuried foot were kept in extending at 90?-120? position.The sequence of hallux replantation was opposed to the classical order and was so called"the retrograde replantating means(RRM)".The order of RRM was defined as follows: skin of toe abdomen→subcutaneous vein of toe abdomen→inhered toe nerve→inhered toe artery→flexor toe tendon→toe fixation by a single K-needle→extendor toe tendon→artery in the back of toe→subcutaneous vein of toe back→skin of bilateral and back.Results Sixteen of eighteen halluces survived replantation(89.9%).The total flexion degree in replanted halluces was 25?～70?.The appearance of amputated toes restored well.The two-point discrimination was 10～16 mm.Eleven cases walked as entirely usually in gait, and seven cases had basic normal gait.Conclusions Replantation of severed halluces could alleviate wound and remnant greatly.The recovery of foot function and aspect of replanted toes was satisfactory.The RRM gradation showed a distinctive advantage that there was no requiring for injuried foot be moved during operation.

Horseradish peroxidase (HRP) has been curently used for tracing the interrelationship between neurons in peripheral and central nervnos system. In order to differentiate endo-and exogenous peroxidases, 15 adult, healthy rats were selected for investigating the distribution of endogenous peroxidase in tissues. Fresh cryostat frozen sections of brain were fixed in fixatives of various concentrations and PH, and sections were made after perfusion of the fixative through heart. They were incubated in media containing DAB and hydrogenperoxide. Potassium cynide or sodium azide was used as inhibitators.The reaction of peroxidase in medula oblongata, pons, midbrain, thalamus, hypothamus, hippocampus and striatum etc were studied with dark field and transmitted light microscope. In the superficial layer of the Ⅲ and Ⅳ ventricles and periaqueductal gray substance of midbrain, there were large number of dark brown peroxidase granules with non neuronal distribution.The peroxidase granules were found in the entire or the dorasal part of locus ceruleus, the ventral part of cerebellum and the dorasal part of hippocampus. Small amount of granules were located in medial nucleus of habenularis, stria medullaris, nucleus supraopticus hypothalami and suprachiasmaticus. Large amount of positive reactive granules were found in nucleus arcuate. Some of them were localized in the perineurons of polydendritic neurons but most of them were of nonneuronal distribution. Sparse granules were also observed in the dorsomedial part of nucleus caudatus putamen and dorsal part of nucleus septicus lateralis. In commisure fornix and corpus callosum, the granules were distributed along the nerve fiber bundle. There were large amount of positive reactive granules around the subfornix organ especially on its dorsal part. To sum up, the main distribution of them are periventricular, periaqueductal gray substance and periventricular organs (such as area postrema, locus coeruleus, nucleus arcuata, subfonix organ and several neurosecretory nuclei of hypothalamus). It seems that the distribution of this enzymes might be closely related to synthesis, metabolism and release of the neurosecretion or transmitters of these nuclei and some of them might act through the cerebro-spinal fluid.

Objectives:To compare the effect of glial cell line-derived neurotrophic factor(GDNF) and methylprednisolone(MP) on intracellular free calcium(［Ca2+］i) and capacity of containing water(CCW) after spinal cord injury(SCI).　Methods:Forty-two SD rats were divided into four groups： control, GDNF,MP and GDNF+MP.GDNF and MP were supplied through subarachnoid cavity, tail vein and both of the above after T12 segments spinal cord injury by modified Allen crush method. Animals were executed and specimens were collected at 24 h, 72 h and 168 h after SCI.［Ca2+］i and CCW were measured using Fura-2 method.　Results:Both ［Ca2+］i and CCW of injured spinal cord in GDNF,MP, and GDNF+MP groups were lower than that of the control group at 24 h and 72 h after SCI(P<0.01).Levels of ［Ca2+］i and CCW in GDNF group was much higher than that of MP and MP+GDNF groups(P<0.01),but there was no difference between MP group and MP+GDNF group(P>0.05) 24 hours after SCI. Seventy-two hours after SCI,［Ca2+］i in GDNF group was higher than that in MP group, MP group was higher than MP+GDNF group(P<0.05).CCW of GDNF group exceeded that of MP and MP+GDNF group(P<0.01).［Ca2+］i in GDNF group was higher than that in MP group, and MP group was higher than MP+GDNF group(P<0.01) 7 days postoperatively, but for CCW, there were no differences among GDNF,MP and MP+GDNF groups(P>0.05).　Conclusions: Both GDNF,MP and GDNF + MP groups might reduce ［Ca2+］i and CCW of injured spinal cord. The curative effect of MP for SCI preponderate over that of GDNF, the effect of MP could be enhanced by adding GDNF.

Based upon our previous experiments of acupuncture analgesia, morphine was adopted for comparison with acupuncture analgesia. Ninty four healthy, adult, male rats were divided into three groups: Two morphine(2,10 mg/kg) and one control group. The pain threshold of 10mg/kg morphine group was similar to that of the acupuncture analgesia; that of the 2mg/kg morphine group varied a great deal individually. Another group of 86 rats were selected and divided into three groups: effective acupuncture group, morphine (10mg/kg) group, and the control. After the measurement of pain threshold, the amount of AChE of the locus coeruleus of the animals was measured with a microphotometer. The ACHE reaction of acupuncture group was significantly increased in comparison with the control as well as with the morphine group. That of morphine group was weaker than the control, though without statistical significance. The number of AChE positive cells in nucleus raphe dorsalis of the acupunctured rats was significantly increased, while no significant difference existed between that of the control and morphine groups.The results showed that both acnpuncture and morphine produced effective analgesia. The former seemed, however, to act upon certain nuclei of the central nervous system possibly through the activities of their enzymes. Neurotransmitters may take active part in analgesia and probably a functional regulation of the organism is involved.

20 adult healthy rats were used for microelectropheretic delivery of horseradish peroxidase (HRP). The diameter of the tip of the glass electrode was around 20～50?. It was inserted into nucleus raphe magnus, 20% HRP was delivered microelectrophoretically(5 ?A for 30 min; 10 ?A for 10 min). In eight rats the microelectrode was withdrawn immediately after the delivery and in the rest it was removed 10～20 minutes after delivery. Afterward the animals were allowed to survive for 40 hrs before decapitation, except 2 for 20 and 2 for 60 hrs. The brains were dissected out for cryostat sections and DAB reaction for peroxidase.The tip of the electrode was located in the nucleus raphe magnus, at the level of nucleus facialis. The diameter of the brain tissues occupied by HRP at the points of microelectophoretic delivery was 0.2～0.4mm and the maximum reached 0.6～0.7mm. The exogenous HRP granules were not visible in the cases with electrodes withdrawn immeditely after delivery and in the survivors of 60 hrs. In most cases the electrodes were left inside for more than 10 minutes after the delivery. The exogenous HRP granules were large, coarse, brown, steroscopic and distributed evenly in the perikaryon of some neurons in several levels of the brain. Those in the axon and dentrite were distributed just like strings of pearls. There were much more neurons with exogenous HRP positive granules dispersed in the reticular formation of the medula oblongata, most of them were polydendritic. Small and fusiformed HRP-positive cells are observed occasionally in the gray substance of subventriculum, reticular formation pontis and ventrolateral side of locus coeruleus. Weaker reactions were found in a few cells in the periaquaductous gray substance of the midbrain, nucleus raphe centro-superior, substantia nigra pars compacta and in the area around the nucleus supraopticus. Besides no HRP-positive cells were discovered in thalamus and subcortex structure.There were two types of cells with HRP positive granules around some blood vessels in reticular formation and subventricular gray substance: One was a small protoplasmic astrocyte with broad cytoplasma, small nucleus, and thick, short and irregular processes and another kind was polydendritic neurons filling with brown positive granules in perikarya and cytoprocesses, in the latter, the HRP positive granules were arranged as strips of pearls.

Objectives:To compare the clinical efficacy between robot-assisted cortical bone trajectory screw(RCBTS)and robot-assisted pedicle screw(RPS)for patients with lumbar spinal stenosis(LSS)undergoing sin-gle-level decompression and fusion.Methods:In this retrospective cohort study,LSS patients who underwent robot-assisted single-level decompression and fusion in Beijing Shijitan Hospital between June 2020 and June 2022 were reviewed.A total of 99 patients were included and divided into RCBTS group of 41 patients and RPS group of 58 patients.There were 59 males and 40 females,with an average age of 67.07±4.65 years old.The incision length,operative time,intraoperative blood loss,24h postoperative drainage,and postopera-tive hospital stay were compared between groups.The Japanese Orthopaedic Association(JOA)score and visual analogue scale(VAS)of low back pain were compared at 3d,3 months and 6 months after operation,and the fixed effects of JOA score and VAS score changes were tested.The screw positions were graded according to the Gertzbein-Robbins method.The accuracy of screw placement of the two surgical methods was evaluated by reviewing the postoperative imaging data.The perioperative and postoperative 3 months of complications were compared between the two groups.Results:There were no significant differences in baseline data be-tween the two groups(P＜0.05).Comparing with the RPS group,the RCBTS group was shorter in operative time(134.39±22.23min vs 152.93±19.10min,P＜0.001),smaller in incision length(64.93±3.71mm vs 78.84±3.82mm,P＜0.001),less in intraoperative blood loss(155.61±37.15mL vs 172.41±43.22mL,P=0.001)and postoperative drainage within 24h(83.66±21.54mL vs 101.21±29.80mL,P=0.002),and shorter in postoperative hospital stay(4.90±1.26d vs 6.26±1.66d,P＜0.001),with statistical significance.There was no significant difference in JOA score and VAS score changes between the two groups at each time point(P＞0.05).The fixed effect test showed that time was a fixed effect of JOA and VAS score changes(P＜0.001).The RCBTS group was no sig-nificantly different from the RPS group in the accuracy of screw placement(grade A:152/164 vs 211/232,P=0.538;grade B:9/164 vs 15/232,P=0.688;grade C:3/164 vs 6/232,P=0.619),the rate of clinically accept-able screw placement(161/164 vs 226/232,P=0.619),the rate of bad screw placement(3/164 vs 6/232,P=0.619),and the incidence of postoperative complications(only 1 patient in the RCBTS group developed delayed wound healing)(P＞0.05).Conclusions:Compared with RPS,RCBTS has significant advantages in operative time,incision length,intraoperative blood loss,volume of postoperative drainage,and postoperative hospital stay.However,there is no significant difference between the two groups in terms of postoperative functional recovery and alleviation in low back pain.

Objectives:To investigate the characteristics of clinical and imaging outcomes and their differ-ences between transforaminal endoscopic decompression and limited decompression and fusion surgery in the treatment of adult degenerative scoliosis(ADS).Methods:From January 2018 to January 2021,53 patients suf-fering from ADS who underwent surgery in our department were retrospectively analyzed,and they were divid-ed into either minimally invasive surgery(MIS)group(31 patients,underwent transforaminal endoscopic decom-pression)or fusion group(22 patients,underwent limited decompression and fusion surgery).The following data were comparatively analyzed:the baseline characteristics,the preoperative Lenke-Silva level,the radiographical parameters(scoliotic Cobb angle,global spinal balance parameters,and spinopelvic parameters)that measured at preoperation,before discharge,at six months after surgery,and at the final follow-up,clinical outcomes that evaluated at preoperation,before discharge,three months after surgery,six months after surgery,and the final follow-up,the incidence of surgical complications,and the reoperation rate.Results:The mean follow-up period was 15.68±3.26 months.The mean age of the patients in the MIS group was significantly higher than that in the fusion group(78.64±5.19 years vs 64.95±4.31 years,P＜0.05).In the MIS group,the majority of the patients were classified as Lenke-Silva Ⅰ and Ⅱ,and all the patients suffered from unilateral lower limb radiculopathy;In the fusion group,more patients were of Lenke-Silva Ⅱ and Ⅲ levels,and 73％of the patients suffered from unilateral lower limb radiculopathy.The preoperative scoliotic Cobb angle in the MIS group was significantly smaller than that in the fusion group(23.92°±9.06° vs 39.58°±13.12°,P＜0.05).Postop-eratively,both groups of patients showed significantly improvement in back pain,leg pain,and functional dis-ability.At the final follow-up,the scores for back pain and functional disability showed preferably improve-ment in the MIS group than those in the fusion group(P＜0.05).During the postoperative follow-up,no coronal or sagittal imbalance was observed in both groups;At the final follow-up:the mean scoliotic Cobb angle pro-gressed 1.51° in the MIS group,while the correction of scoliosis reduced 1.82° in the fusion group.The op-erative time,intraoperative blood loss,incidence of complications,and the reoperation rate in the MIS group were significantly lower than those in the fusion group(P＜0.05).Conclusions:For ADS patients without rigid imbalance,both surgical interventions are able to significantly improve clinical symptoms.The short-term fol-low-up outcomes reveal that the endoscopic decompression superiors in less scoliosis progression after opera-tion and functional improvement than limited fusion surgery.