Pedicle screw instrumentation has become the standard stabilization of the posterior lumbar spine.Loosening due to osteoporosis is the common reason for failure.Bone cement augmentation is regarded as an efficient way to enhance screw strength in osteoporotic bones.In this review,a brief introduction to the recent advances in researches on the biomechanics of the bone-screw interface,the pedicle screw augmentation technique and the materials of bone cement is presented.The paper emphasizes the significance of studies on the augmentation indications,vicariousness activity in osteoporosis sclerotin and the strength.

Objective To explore the curative effect of quetiapine combined with paroxetine in the treatment of bipolar depression,and to provide reference for the choice of clinical treatment.Methods According to the digital table,96 patients with bipolar disorder were randomly divided into observation group and control group,48 cases in each group.The control group was treated with quetiapine orally,the observation group was treated with quetiapine combined with paroxetine.After 6 weeks of treatment,the clinical curative effect,the Montgomery Asberg Depression Rating Scale and the Beck pull fan Sen Mania Rating table score before and after treatment were compared between the two groups.At the same time,the adverse reactions of the two groups were compared.Results After 6 weeks of treatment,the total effective rate of the observation group was 70.83％,which was significantly higher than 50.00％ in the control group,the difference was statistically significant(x2 =4.356,P =0.037).After 6 weeks of treatment,the Montgomery Asberg Depression Rating quantity score in the observation group was (14.01 ± 2.95) points,which was significantly lower than (18.07 ± 3.05)points in the control group,the difference was statistically significant (t =5.527,P =0.036).The Baker-pull fan Sen Mania Rating score before and after treatment between the two groups had no statistically significant differences.There were no serious adverse reactions in the two groups.Conclusion Quetiapine combined with paroxetine can effectively inhibit bipolar depressive episodes,avoid manic episodes,has good clinical efficacy and high safety,it is worthy of popularization and application.

Objective To study effects of shuganjieyu capsule of plasma glucose and lipid metabolism and sleep and body weight in patients with depression.Methods 90 patients of depression who received therapy from July 2013 to July 2016 in our hospital were selected.According to random number table, those patients were divided into the observation group ( n =45 ) and the control group ( n =45 ) .The control group was treated with citalopram, while the observation group was treated with shuganjieyu capsule, then glucose and lipid metabolism, sleep, weight and clinical curative effect were compared.Results After treatment, the fasting blood glucose (FBG), postprandial 2h blood glucose (2 hPG), triacylglycerol (TG), total cholesterol (TC) in the observation group were lower than the control group(all P<0.05), the sleep state self rating scale (SRSS) and the Pittsburgh sleep quality index ( PSQI) in the observation group were lower than the control group ( all P <0.05 ) .The body weight and body mass index in the observation group were lower than the control group (all P<0.05).The total effective rate in the observation group 95.56% (43/45)was higher than the control group 77.78% (35/45) (P<0.05); the incidence of adverse reactions in observation group 20.00% (9/45) was lower the control group 46.67% (21/45) ( P <0.05).Conclusion Shuganjieyu capsule is well for depression, which can conducive to maintaining glucose and lipid metabolism, weight stability, and improve sleep quality and clinical symptoms, and high security,it's worthy of application and promotion.

AIM: DNA vaccines expressing protective domain of surface protective antigen A（spaA）of Erysipelothrix rhusiopathiae have been relatively ineffective at generating high-titer, long-lasting, neutralizing antibodies in murine models. METHODS: This paper report using a DNA vaccine expressing a fusion of the spaA protein and various elements, such as a secretion leader sequence from the highly expressed human gene encoding α1-antitrypsin (AAT), a highly soluble and stably folded domain from the rat cartilage oligomerization matrix protein (COMP), and three copies of the complement component, C3d3, to enhance the titers of neutralizing spaＡ-specific antibody. RESULTS: Analysis of titers of the antibody raised in vaccinated mice at different time points indicated that immunizations with the DNA expressing pcDNA3-AAT-COMP-spaAN-3C3d((pcD-ACSC)) had higher titers than pcDNA3-spaA_N(pcD-S) at weeks 4. Furthermore, the immune protective efficacy of the spaA-chimeras was demonstrated by lethal challenge with a virulent homologous strain 1249 against immunized mice. CONCLUSION: These results suggest that using a plasmid vector containing a strong heterologous signal sequence that mediate efficient antigen secretion in vivo and a fused piece of sequence improving antigens solubility, as well as C3d3, genetic adjuvant, could enhance the antibody responses level. This approach might be an efficient way to improve the antibody level of spaA_N DNA vaccination.

Objective:To explore the influence of rosuvastatin in the lipid levels, atherosclerosis plaque and apoptosis in the plaque of atherosclerotic apolipoprotein E (ApoE)-knockout mouse models, and to clarify the mechanism of rosuvastatin in inhibiting atheromatous plaque and apoptosis in the plaque.Methods:Thirty healthy six-week old male mice were randomly divided into high fat diet group (n=10),rosuvastatin group (n=10)and general diet control group (n=10).The mice in first two groups were fed with high fat diet,and the mice in general diet control group were fed with general diet;4 weeks later the mice in three groups were respectively given 0.9% NaCl solution,rosuvastatin (10 mg·kg·d-1 )and 0.9% NaCl solution by gavage for 8 weeks.And then ELISA was used to detect the serum lipid levels,the area of atherosclerotic plaque was measured by HE staining, and the apoptosis in plaques was detected by TUNEL method;the expression of apoptosis-assoicated gene Bax protein was measured by immunohistochemical staining.Results:Compared with high fat diet group,the levels of total cholesterol (TC)and low density lipoprotein cholesterol (LDL-C)of the mice in rosuvastatin group were significantly decreased (P<0.05 or P<0.01),and the 1evel of high density lipoprotein cholesterol (HDL-C)was significantly increased (P<0.01).The aortic atherosclerotic plaque of the mice in high fat diet group was massive with a great quantity of foam cells, cholesterol crystal, necrotic cells and inflammatory cells in the plaque;the aortic atherosclerotic plaque of the mice in rosuvastatin group was smaller with less foam cells,necrotic cells and inflammatory cells;the aortic atherosclerotic plaque area of the mice in rosuvastatin group was significantly smaller than that in high fat diet group (P<0.01);the apoptotic index in the aortic atherosclerotic plaque of the mice in rosuvastatin group was significantly lower than that in high fat diet group (P<0.01).Compared with high fat diet group,the expression of Bax protein in rosuvastatin group was significantly decreased.Conclusion:Rosuvastatin may inhibit the progression of atherosclerotic plaque and the apoptosis in plaques through mitochondrial pathway.

Objective:To explore the influence of Shenhong Tongluo Granules in the lipid levels,atherosclerosis plaques and apoptosis in the plaques of atherosclerotic apolipoprotein E (ApoE)-knokout mice,and to clarify the mechanism of Shenhong Tongluo Granules in anti-atherosclerosis.Methods:Forty SPF male mice aged six-week old were randomly divided into normal control group,model group,low dose of traditional chinese medicine (TCM) group and high dose of TCM group (n=10)after fed adaptively for 1 week.The mice in normal control group were fed with normal diet continuously, the mice in other three groups were fed with high fat diet to establish atherosclerosis model,and then the mice in low and high doses of TCM groups were respectively given Shenhong Tongluo Granules (5.06 and 10.12 g·kg-1 · d-1 )by gavage for 6 weeks. The levels of serum total cholesterol (TC),triglycerides (TG),low density lipoprotein cholesterol (LDL-C)and high density lipoprotein cholesterol (HDL-C)of the mice in various groups were measured after the eyeball blood was collected.The aortic arch tissue was separated,and the morphotogy and the areas of atherosclerotic plaques were observed and calculated by HE staining;the apoptosis in plaques of the mice was evaluated by TUNEL method, and the apoptosis index was calculated. The expressions of apoptosis-assoicated gene Bcl-2 and Bax protein were measured by immunohistochemical staining.Results:The serum level of TG in low dose of TCM group was lower than that in model group (P <0.05);the serum levels of HDL-C in low and high doses of TCM groups were lower than that in model group (P <0.05 or P <0.01);the serum levels of TG and HDL-C in high dose of TCM group was higher than that in low dose of TCM group (P <0.05).The areas of atherosclerotic plaques of the mice in low and high doses of TCM groups were significantly smaller than that in model group (P <0.01).The apoptosis index of mice in low and high doses of TCM groups were significantly lower than that in model group (P <0.01);the expression levels of Bcl-2 protein in atherosclerosis plaques of the mice in low and high doses of TCM groups were lower than that in model group,while the expression levels of Bax were significantly higher than that in model group (P <0.05 or P <0.01).Conclusion:Shenhong Tongluo Granules could effectively reduce the serum lipid level of ApoE-/-mice,meanwhile it could inhibit apoptosis by regulating the expressions of Bcl-2 and Bax protein,and then inhibit the progression of atherosclerotic plaques.

OBJECTIVE: To investigate the effect of balloon kyphoplasty combined with bone cement on the treatment osteoporotic vertebral fracture.METHODS: A total of 58 aged patients with single osteoporotic vertebral compression fracture (58 vertebral bodies) were treated with balloon kyphoplasty. The fracture always occurred at T_8-L_4 segment of vertebral body in particular at T_(10)-L_2 segment of thoracic waist. By local anesthesia, lateral or bilateral pedicle of vertebral arch was punctured to injection bone cement under C-arm fluoroscopy.RESULTS: Bone cement leakage occurred in 8 cases, including leakage along posterior longitudinal ligament into adjacent posterior margin of vertebral body (n=1), external edge of vertebral body (n=6), and subcutaneous tissue (n=1); however, all the patients did not have clinical symptoms. C-arm fluoroscopy showed that height of vertebral body was increased, and rachiokyphosis was improved after treatment. Pain was obviously improved, and the easement rate of pain was 100%. There was significant difference in visual simulation score, angle degree of rachiokyphosis, and living activity scale before and 6 months after treatment (P < 0.05), but there was no significant difference between 6 months after treatment and following up stopping (P>0.05).CONCLUSION: Balloon kyphoplasty can significantly ease pain caused by osteoporotic spinal fractures and tumor metastatic spinal fractures and can partially restore vertebral body height and kyphosis deformity, there is conducive to improving spinal function and improving the quality of life.

Nonunion is the interruption of fracture healing process for a variety of reasons.The cause of the disease is different,and the treatment method is also different.Non-infective nonunion is that there are no local infection factors when nonunion occurs after wound and fracture,and it is most common in all nouunion.However,it is still a difficult problem for clinical orthopaedics.With the development of medical technology orthopaedics attach great importance to this kind of nonunion and study it deeply,its incidence is getting lower and lower.Despite brilliant results,the treatment for this kind of nonunion remains tricky.The treatment of non-infective nonunion can be divided into conservative treatment and surgical treatment,and the latter is still the main treatment.This article gives a systematic review of the treatment of non-infective nonunion.

Objective To investigate the clinical efficacy of bone grafts containing bone morphogenetic protein 2 (Bone Conduction) treating of nonunion of femoral fracture after intramedullary nailing.Methods The clinical data of 49 patients with nonunion of femoral fracture after intramedullary nailing from August 2008 to August 2016 were analyzed retrospectively.They were divided into experimental group and control group according to different bone grafting methods.The experimental group (n =23) was treated with Bone Conduction combined with allograft bone grafting.The control group (n =26) was treated with autogenous bone grafting.The autogenous bone was taken from the ipsilateral ilium.The two groups were compared operative time,intraoperative blood loss,postoperative wound complications,hospitalization time,postoperative visual analog scale,mean image healing time and the score for distal femoral fractures after the operation.All patients were followed up for 12 to 24 months.Follow-up methods were divided into telephone follow-up and outpatient follow-up.The patients were followed up for outpatients before fracture healing.The patients were followed up by telephone after fracture healing.The healing time of fracture,the flexion and extension activities of the knee joint at 9 months after operation were recorded.SPSS19.0 statistical software was used to analyze the data.Measurement data were expressed as ((x) ±s).The independent sample t test was adopted in measurement data and the counting data was tested by Chi-squared test.Result In the experimental group,operative time was (138.7 ± 34.6) minutes,intraoperative blood loss was (315.4 ± 52.8) ml,postoperative wound complications was 0 case,hospitalization time was (8 ± 3) days,postoperative visual analog scale was 5 scores,but in the control group,operative time was (170.5 ± 32.5) minutes,intraoperative blood loss was (367.2 ± 56.4) ml,postoperative wound complications was 3 cases,hospitalization time was (13 ± 2) days,postoperative visual analog scale was 8 scores.There were significant differences between the two groups,P ＜0.05.All patients who followed up for 12-24 months were recovered,with an average follow-up of 15 months.Mean image healing time in the experimental group and control group was separately(4.9± 2.5) months,(5.2 ± 2.8) months.The excellent and good rates ofthe score for distal femoral fractures 9 months after the operation was separately 95.7％,96.2％,there was no significant difference between the two groups,P ＞ 0.05.Conclusions Bone graft material containing bone morphogenetic protein 2 (Bone Conduction) has the advantages of simple operation,less trauma,less complications,high osteogenic activity and good bone graft effect are equalled with iliac bone graft,the bone graft material containing bone morphogene protein is an effective method to treat nonunion of femoral fracture after intramedullary nail.

Objective: To explore the correlation between antithrombotic strategy and its prognostic value in coronary artery disease (CAD) patients combining with atrial ifbrillation (AF) after percutaneous coronary intervention (PCI).
Methods: A total of 570 CAD patients with AF received PCI in our hospital from 2012-01 to 2013-12 were retrospectively analyzed by CHADS2 and HAS-BLED Score system. According to CHADS2 < 2 and CHADS2 ≥ 2 or with/without warfarin medication, the patients were divided into 2 groups:①CHADS2 < 2 (Low risk of stroke) group,n=339 including 309 patients without warfarin and 30 with warfarin medication;②CHADS2 ≥ 2 (High risk of stroke) group,n=231 including 200 patients without warfarin and 31 with warfarin medication. All patients were followed-up for 15 months to compare the different anti-platelet/ anti-coagulation strategies for the occurrence rate of MACCE, ischemic and bleeding events.
Results: Compared with Low risk of stroke group, the patients in High risk of stroke group had the worse prognosis and higher rate of MACCE occurrence,P<0.001, HR=2.677, 95% CI (1.535-4.635), more ischemic events,P=0.013, HR=2.080, 95% CI (1.167-3.709). Multi-factor Cox surving analysis indicated that compared with low risk patients without warfarin medication, the high risk patients without warfarin had the higher rate of MACCE occurrence,P=0.001, HR=2.985, 95% CI (1.532-5.816), more ischemic events,P=0.026, HR=2.068, 95% CI (1.090-3.925). Whereas, the occurrence rates of MACCE and ischemic events in high risk, low risk patients with warfarin and low risk patients without warfarin were similar, all P>0.05. The major bleeding events in patients with warfarin were a little higher than those without warfarin,P>0.05. The minor bleeding events were increased in both Low risk stroke group asP<0.001, OR=4.458, 95% CI (1.934-10.277) and High risk stroke group asP=0.002, OR=4.155, 95% CI (1.717-10.055).
Conclusion: Warfarin medication may obviously decrease the occurrence rates of MACCE and ischemic events in high risk of stroke patients, while in low risk patients, warfarin could not further decrease the occurrence of MACCE and ischemic events. Warfarin could increase the risk for minor bleeding in both low risk and high risk of stroke in CAD patients combining with AF after PCI.