Objective To investigate the effect of ketamine injected via the radicular arteries on spinal cord. Methods Twenty healthy mongrel dogs of both sexes weighing 12-18 kg were randomly divided into 2 groups ( n = 10 each): control group (group C) and ketamine group (group K). The animals were anesthetized with intravenous pentobarbital 30-35 mg/kg, fentanyl 50-100 μg and vecuronium 0.2 mg/kg and maintained with propofol ically ventilated after tracheal intubation. A catheter was inserted into T8 poster intercostal artery and advanced toward the opening of radicular artery which supplies the spinal cord. Ketamine 100 mg (in 2 ml of normal saline)was injected via the catheter in group K. Three hours after ketamine administration, the animals were sacrificed. A 1.5 cm long segment of spinal cord at the level of T8 was removed for microscopic examination and determination of the expression of NSE, S100β and Tau protein by immuno-histochemistry. Results There was no significant difference in the number of Nissl' s staining-negative neuronal cells and the expression of NSE, S100β and Tau protein in the spinal cord between the 2 groups ( P ＞ 0.05 ). Conclusion Ketamine injected via the radicular arteries does not induce spinal cord injury.

Objective To investigate the injury of podocyte and its association with proteinuria in IgA nephropathy (IgAN). Method Thirty-five patients of IgA nephropathy with proteinuria more than 1.0 g/24 h were enrolled in the study, and eight cases of renal harmatomaeetomy or renal cancinomaectomy were as controls. Cell cycle regulatory proteins (p21, p27), podocyte-associated molecules (integrin-β1, nephrin, α-actinin 4, nestin), foot process width (FPW) and the amount of podocyte were examined by immunohistochemistry and real-time PCR, respectively. Patients were divided into two groups according to podocyte number per volume (Nv): podocytopenia group (n=15, Nv<52.49×106/μm3) and normal number group (n=20, Nv≥52.49× 106/μm3). Proteinuria was followed up for eighteen months. Results Compared with the controls, podocyte p21 was re-expressed, while the expression of p27 was decreased (0.71±0.12 vs 0.91±0.07, P<0.05) in IgAN. The nestin protein level was markedly decreased in IgAN (13.4%± 0.04% vs 17.6%±0.04%, P<0.05). The mRNA expression of integrin-β1 was significantly increased (12.54±5.20 vs 1.02±0.30, P<0.05), while the amount of nephrin, α-actinin4 remained unchanged. Effacement of foot processes and podocyte detachment from the glomerulax basement membrane were observed in some cases. Nv was significantly less than that of controls (161.27± 225.92 vs 323.22±138.12, P<0.05), which was associated with the Lee's grade of IgA nephropathy. The integrin-β1 mRNA expression and Nv were negatively correlated with baseline proteinuria by univariate analysis (r=-0.840, P=0.034; r =-0.4483, P=0.014, respectively). Proteinuria in podocytopenia group was decreased more slowly than that in normal number group. Conclusions Podocyte injury exsists in IgAN with proteinuria, which manifests alterations in cell cycle regulatory protein and some podocyte-associated molecules, as well as foot process effacement and loss of pedocyte. Podocyte injury may be involved in proteinuria by affecting the progression of proteinuria in IgAN.

Searching for new antidiabetic lead compound, 4-(1-aryl-3-oxo-5-phenylpentylamino) benzenesulfonamides were designed and synthesized directly by three component one-pot condensation of 4-phenyl-2-butanone and sulfanilamide with some aromatic aldehydes at an yield of 23%-97%. The chemical structures of the twelve new Mannich bases were confirmed by 1H NMR, 13C NMR, FTIR, ESI-MS and HR-MS. The screening results of antidiabetic activity indicated that most of these title compounds possess alpha-glucosidase inhibitory activity, among which compound le is the strongest one. And compound 11 possesses good peroxisome proliferator-activated receptor response element (PPRE) agonist activity. The structure-activity relationship of these new beta-amino ketones containing benzenesulfonamide unit was also discussed preliminarily.

Objective To evaluate the clinical outcome of bleeding control by preoperative embolization of internal iliac artery with DSA and intra?operative presetting abdominal aorta balloon, combine with the operation techniques of exposure, reduc?tion and internal fixation of pelvic fracture through lateral?rectus approach. Methods From March 2012 to May 2015, 7 patients with type C3 pelvic fractures admitted to our department from March 2012 to May 2015, treated with preoperative embolization of internal iliac artery under digital subtraction angiography 2 h before surgery and presetting abdominal aorta balloon were retrospec?tively reviewed. There were 3 males and 4 females, with an average age of 34 years (range, 16 to 61 years). According to AO classi?fication, all 7 cases belonged to type C3 (3.2:5 cases;C3.3:2 cases), including 5 cases with limb fracture, 2 cases with craniocere?bral trauma, 4 cases with pulmonary contusion, 2 cases with injury of abdominsal organs. Time from injury to operation was 19 days on average (10 to 33 days). Patients received damage control surgery treatment including bleeding control and temporary ex?ternal fixation, and ipsilateral tractions with heavy weight, intensive care and corrections of general situation before operation. The fracture model was manufactured by 3D printing and fracture reduction was simulated on computer preoperatively. Embolization of internal iliac artery was performed in the side of severe displaced sacroiliac joint with DSA 2 hours preoperatively. Reduction was performed to stabilize anterior-posterior pelvic ring and acetabular fractures via the intraoperative lateral?rectus approach. And 2 cases were performed by temporary balloon occlusion of abdominal aorta (≤60 min) for bleeding control in reduction of in the side of sacroiliac joint fractures. Results All the 7 cases had undergone the operations successfully, and the operating time was from 135-320 min with blood loss from 440-3 350 ml. According to Matta radiological evaluation postoperatively, reduction of pelvic fracture was rated as anatomic in 5 cases, satisfactory in 2, without complications. All 7 cases were complicated with lumbosacral plexus injury or lumbosacral trunk injury at different degrees (M0 2 cases, M1 2 cases, M2 2 cases, M3 1 case). According to the BMRC scoring system, 5 cases had well recovered and the other 2 cases had no improvement after three months (M4 2 cases, M5 3 cases). Conclusion Surgical management of pelvic fracture through preoperative internal iliac artery embolization and intra?oper?ative occlusion of abdominal aorta could effective control bleeding and achieve favorable conditions for reduction. Lateral?rectus approach can provide adequate exposure of the anterior and posterior ring, and this approach could also provide excellent visual control of reduction and fixation.

Objective To assess the effects of axial spinous process-muscle-vascellum complex transplantation for posterior atlantoarial fusion.Methods Data of 27 cases with altantoarial disease who were treated by posterior atlantoarial fusion using axial spinous process-muscle-vascellum complex transplantation from June 2015 to June 2016 were retrospectively analyzed.There were 19 males and 8 females aged from 9 to 68 years old (mean,41.0±15.4 years old).Two cases were diagnosed with atlanto-axial instability.Fourteen cases were diagnosed with atlas fracture and eleven cases were diagnosed atlanto-axial fracture.All the 27 patients suffered from neck pain or limitations of cervical motion.All patients were assessed clinically by atlantoaxial reduction and bone graft fusion.The pre-operative and post-operative atlanto-dens interval (ADI),visual analogue scale (VAS),Japanese Orthopaedic Association scores (JOA),improvement rate of JOA score and axial symptoms were measured and statistically analyzed.Complications were recorded.Clinical outcome of latest follow-up was evaluated by X-ray and CT scan.Results The time of operation was 2.0-2.5 h and blood loss was 150-300 ml.All the patients were followed-up for 9 to 18 months (mean,11.5±2.1 months).The VAS of neck pain improved from 3.6±2.7 (range,2.0-5.0) pre-operatively to 1.4±0.2 (range,0-2.0) 12 months postoperatively (P=0.000).The JOA score improved from 11.7± 1.9 (range,10.0-15.0) pre-operatively to 15.3±0.6 (range,14.0-17.0)12 months post-operatively (P=0.000).The improvement rate of JOA score at the latest follow-up was 54.1％± 12.4％,including 23 cases (85.19％) excellent,and 4 cases (14.81％) good.The results of axial symptoms were no-symptom in 22 cases (81.48％) and mild symptoms in 5 cases (18.52％).Postoperative cervical spine X-ray and CT showed that the sagittal cervical spine alignment was restored.There was statistically significant difference between ADI of 4.3±1.1 mm (range,3.9-4.5 mm) pre-operatively to 2.5± 0.4 mm (range,2.1-2.6 mm) 12 months post-operatively,which was improved significantly (P=0.000).There were no complications found during the follow-up.Conclusion The application of axial spinous process-muscle-vascellum complex transplantation for posterior atlantoaxial fixation can preserve the dynamic function of muscles and reduce the postoperative pain,as well as avoid donor site morbidity.

OBJECTIVETo investigate the effects of the mixed endothelin receptor antagonist, bosentan, combined with the long-acting calcium channel blocker, amlodipine, compared to the angiotensin-converting enzyme inhibitor, cilazapril, on the progressive renal injury in spontaneous hypertensive rats (SHR) with diabetes.

METHODSDiabetic hypertensive rats (SHR-DM) were induced by streptozotozin injected in male SHR (7-week-old),and divided into an untreated and three treated groups: 1) cilazapril treated group; 2) bosentan+amlodipine treated group; and 3) amlodipine treated group. Wistar Kyoto rats (WKY) and SHR rats served as normotensive and hypertensive control, respectively. The mean arterial blood pressure, renal function, endothelin and angiotensin II levels as well as the protein expression of renal extracellular matrix components and transforming growth factor (TGF)-beta1 were determined at the end of the 4th week.

RESULTSMean arterial blood pressure significantly increased in SHR and SHR-DM rats compared to WKY rats. All the therapies reduced the blood pressure to normal levels. However, the enhanced urinary protein excretion, the decreased creatinine clearance as well as the increased plasma and intrarenal endothelin and angiotens in II levels were found in the untreated SHR-DM and prevented by treatment with bosentan+amlodipine and cilazapril. Similarly, these two kinds of therapies in SHR-DM abolished the overexpression of renal TGF-beta1 by Western blot analysis and reduced the accumulation of collagen type IV, laminin and fibronectin proteins by an immunochemical approach. Amlodipine monotherapy had no detectable effects on the above parameters.

CONCLUSIONBosentan combined with amlodipine can offer similar renoprotective effects on that of cilazapril and may be a potent therapy to attenuate renal injury by reducing renal protein levels of TGF-beta1 in diabetes with a hypertensive state.

Amlodipine ; administration & dosage ; Angiotensin II ; analysis ; Animals ; Calcium Channel Blockers ; administration & dosage ; Collagen Type IV ; analysis ; Diabetic Nephropathies ; prevention & control ; Drug Therapy, Combination ; Endothelin Receptor Antagonists ; Hypertension ; complications ; drug therapy ; Kidney ; drug effects ; Male ; Rats ; Rats, Inbred SHR ; Rats, Inbred WKY ; Sulfonamides ; administration & dosage ; Transforming Growth Factor beta ; analysis ; Transforming Growth Factor beta1

Objective:To investigate the efficacy of screw-rod fixation and fusion in revision surgery after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty(PKP) for osteoporotic vertebral fractures (OVFs).Methods:A retrospective case series study was carried out on clinical data of 19 patients treated by revision surgery after PVP or PKP at Zhejiang Ningbo No.6 Hospital from January 2014 to December 2017. There were 5 males and 14 females, with age of (70.7±6.0)years (range, 58-81 years). Injured segment was located at T 9 in 1 patient, T 11 in 3, T 12 in 5, L 1 fracture in 5, L 2 in 2, L 3 in 2 and L 4 in 1. Caused for revision and operation methods were as follows, 5 patients underwent debridement, screw-rod fixation and fusion due to infection, 9 patients underwent osteotomy due to progressive kyphosis, screw-rod fixation and fusion, 5 patients underwent spinal canal decompression, screw-rod fixation and fusion due to neurological dysfunction. The operation time, intraoperative blood loss, and perioperative complications were recorded. The white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to evaluate the control of infection before operation, before discharge and at postoperative 3 months. The changes in Cobb angle were measured before and after operation and at the final follow-up. The American spinal injury association (ASIA) scale, visual analog scale (VAS) and Oswestry disability index (ODI) were evaluated at the final follow-up. Results:All patients were followed up for 24-46 months [(32.7±8.3)months]. The revision operation time was 135-320 minutes [(226.3±75.6)minutes]. The intraoperative blood loss was 350-1 500 ml [(825.5±230.6)ml]. There were 1 patient with poor wound healing, 2 with pulmonary infection, and 2 with hardware loosening. The WBC, ESR and CRP decreased from preoperative (9.2±1.7)×10 9/L, (88.7±19.2)mm/h, (58.7±22.9)mg/L to (7.3±0.9)×10 9/L, (42.5±13.7)mm/h, (37.3±16.3)mg/L before discharge, and (6.6±0.7)×10 9/L, (26.8±9.5)mm/h, (17.8±8.6)mg/L at postoperative 3 months ( P<0.01). The Cobb angle improved from preoperative (29.3±5.2)° to (4.8±1.2)° ofter operation and (7.3±1.6)° at the final follow-up ( P<0.05). The patients with ASIA grade C ( n=2) and grade D ( n=1) improved to grade E, and the patients with ASIA grade C ( n=2) improved to grade D at the final follow-up. Imagines showed good bone fusion in all patients at the last follow-up. The mean VAS decreased from preoperative (7.5±0.8)points to (2.1±0.5)points at the last follow-up ( P<0.05). The ODI decreased from preoperative (60.7±15.2)% to (19.9±5.9)% at the last follow-up ( P<0.05). Conclusion:For patients with OVFs undergoing revision surgery after PVP or PKP, debridement, kyphosis correction, spinal canal decompression combined with screw-rod fixation and fusion can reduce infection, correct kyphotic deformity, improve neurological function, relieve pain and improve quality of life.

Objective To evaluate the feasibility, safety and efficacy of the treatment of chronic symptomatic internal carotid artery long?segmental occlusion. Methods Fifty?one cases of chronic symptomatic internal carotid artery long?segmental occlusion (arterial occlusion more than 2 anatomical segments) who were treated with hybrid surgery (plaque located at the carotid sinus) or endovascular revascularization (plaque located at the distal end of the internal carotid artery occlusion) from May 2015 to May 2018 were reviewed. Recanalization, perioperative complications, stroke events, and reocclusion events during the follow?up period were recorded. Results The occlusion was recanalized successfully in 45 of 51 patients (88.2%, 45/51), 6 patients failed because the guidewire could not cross the distal arterial occlusion. And the technical success rate was 96.0% (24/25) in hybrid surgery and 80.8% (21/26) in endovascular revascularization. Perioperative complications occurred in 2 patients who underwent combined endovascular treatment. One patient had a small branch embolism due to intraoperative thrombus shift, and 1 patient had large area cerebral infarction. The complications occurred in 2 patients who underwent thybrid surgery, including 1 case of internal carotid cavernous fistula and 1 case of acute reocclusion of internal carotid artery. Forty?four patients with successful operation received clinical follow?up, with the median follow?up time of 24 months (7-43 months). No recurrent stroke and death occurred during the follow?up period. Clinical symptoms were improved in 34 cases. Totally 44 patients received imaging follow?up, and during the median imaging follow?up time of 8 month (4-28 months), 6 cases had reocclusion, and 2 cases had restenosis. Conclusion The treatment of chronic symptomatic internal carotid artery long?segmental occlusion is technically feasible and safety with good short?term efficacy. However, its exact efficacy remains to be confirmed by long?term follow?up studies with large samples.

Objective:To investigate the anatomical safety and feasibility ofposterior occipitocervical fixation with atlan-tooccipital-clivus screw.Methods:Data of 60 patients who treated in the spinal department of our hospital with upper cervical computed tomographic scans from February 2017 to November 2019 were retrospectively collected. Occipitocervical infection, injury, tumor and deformity were excluded. The Mimics software was used to reconstruct the occiput, atlas and measure the anatomical parameters, including the height and width of the anterior edge of the clivus, the height and width of the middle part of the clivus, the thinnest distance of the soft tissue in front of the clivus, the anteroposterior diameter, transverse diameter, the angle of inside tilting in coronary plane of the occipital condyle, the distance from the hypoglossal canal to the atlantooccipital articular surface, the anteroposterior diameter and transverse diameter of the superior joint of atlas, the height of the lateral mass, and the height and transverse diameter of the inferior articular process of the superior atlas joint. The three-dimensional digital modeling was performed and the screw diameter of 3.5mm was simulated. 3-Matic software were used to measure the screw placement parameters, including the inside tilting angle in coronary plane of screw, and the angle of upper tilting in sagittal plane and length of screw. The atlanto-occipital junction was exposed at the rear of 8 cadavers. According to the above parameters, the titanium alloy screws with a diameter of 3.5 mm were transferred from the inferior articular process and posterior arch of the atlas to the clivus through the atlantooccipital. Finally, the screw path was cut along the nail path with a pendulum saw, and the track of the screw was observed to confirm the safety and effectiveness of the screw.Results:The leading edge height and width of male clivus was 16.8±2.5 mm and 20.1±3.1 mm. The middle part of the clivus was 9.7±2.3 mm and 22.4±3.7 mm. The thinnest soft tissue in front of the clivus was 5.8±1.48 mm. The anteroposterior diameter of the occipital condyle was 19.1±1.9 mm, the transverse diameter was 12.6±2.0 mm, the inside tilting angle was 33.7°±4.5°, and the vertical distance from the lowest point of the neural tube to the articular surface of the occipital condyle was 9.6±1.1 mm. The height of the lateral mass of atlas was 12.9±2.4 mm, the anteroposterior diameter of the upper joint of atlas was 21.7±1.9 mm, and the transverse diameter was 11.7±1.4 mm. The width of the inferior facet was 14.9±1.4 mm and the height of the inferior facet was 5.7±0.85 mm. The distance from the screw entry point to the vertical line of the lateral mass migration midpoint was 2.5±0.6 mm; The distance from the screw entry point to the horizontal line of the midpoint was 2.3±0.7 mm.The inside titling angle of screw was 18.4°±1.6°, the upper tilting angle was 55.6°±3.1°, the length of the screw track was 53.0±2.8 mm, the adjustment range of upper tilting angle was 15.0±2.8 mm, the adjustment range of inside tilting angle was 10.4±2.4 mm. The anatomical parameters of females were slightly smaller than those of males, and the difference was statistically significant, but there was no significant difference between left and right parameters. The screws of 8 specimens could be inserted safely and effectively.Conclusion:Atlan-tooccipital-clivus screw can be implanted without damaging the nerve and vascular structure, and it can be used as a choice for occipitocervical fixation.

Objective:To investigate the clinical value of totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization for portal hypertension com-plicated with splenic aneurysm.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 17 patients with portal hypertension complicated with splenic aneurysm who were admitted to 2 medical centers (15 cases in Shenzhen University General Hospital and 2 cases in Wuhan First Hospital) from January 2013 to May 2020 were collected. There were 7 males and 10 females, aged (59±14)years. All patients underwent totally laparoscopic exoclusion of splenic artery aneurysm combined with pericardial devascularization. Observation indicators : (1) surgical and postoperative conditions; (2) complications; (3) follow-up. Follow-up was conducted by out-patient examiantion and telephone interview to detect the effect of exclusion of arterial tumor, and blood re-flow, portal vein thrombosis and survival of patients 3 months after operation. The follow-up was up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Results:(1) Surgical and postoperative conditions. All 17 patients successfully completed the operation, without perioperative death. The operation time, volume of intraoperative blood loss of 17 patients were (181±30)minutes, 187(range, 90?420)mL. The white blood cell count, red blood cell count, hemoglobin, serum albumin were (9±4)×10 9/L, (3.5±0.9)×10 12/L, (86±17)g/L, (36±7)g/L on the postoperative day 3. Time to postoperative abdominal drainage tube removal and duration of post-operative hospital stay were (7±4)days and (11±4)days. (2) Complications. All 17 patients had ascites after surgery, which were improved after oral treatment with diuretics. There was no complication such as intra-abdominal hemorrhage, gastrointestinal fistula, pleural effusion, infection, abscess formation, fever and vascular embolism. (3) Follow-up. All the 17 patients were followed up for 28.6(range, 7.0?84.0)months. During the follow-up, the splenic aneurysm cavity of all patients was completely isolated, no blood re-flow and no portal vein thrombosis was observed, and no patient died. Conclusion:Totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization is safe and feasible in the treatment of portal hypertension complicated with splenic aneurysm.