[Objective]A prospective comparative evaluation of fulcrum bending radiographs(fulcrum)to determine curve flexibility and predict surgical correction in adolescent idiopathic scoliosis(AIS).[Method]A total of 64 consecutive patients with AlS according to inclusion and exclusion criterias who underwent surgical treatment were studied.All curve types were single-curve and the PUMC classification were Ia/Ib/Ic.All patients were divided into 4 groups according to the magnitude of Cobbs angle in preoperative standing anteroposterior radiograph:moderate thoracic curve(20 cases,40?60?),moderate lumbar curve(21cases,35?60?).The Cobbs angles were measured and the flexibility ratio was determined on fulcrum radiograph.The amount of correction obtained by fulcrum radiograph was compared with the amount of surgical correction by evaluating the differences from surgery as absolute values.The correlation of Cobbs angles between postoperative standing anteroposterior radiograph and fulcrum radiograph were analyzed.[Result]For the moderate thoracic curves,curve flexibility provided by fulcrum radiograph has no significant difference(P=0.141)from surgical curve correction,there was no significant difference(P=0.094)between the mean Cobbs angle on fulcrum bending and that on postoperative standing anteroposterior radiograph.The postoperative Cobbs angle was positively correlated with the preoperative Cobbs angle on fulcrum radiograph and the correlation degree in the moderate lumbar curve was relatively weak.[Conclusion]Fulcrum radiograph can only be used to assess the flexibility and correction of moderate thoracic curves in AIS.Pedicle screw instrumentation provides even more correction.

Objectives:Using IE 1 gene promoter of Autograph californica nuclear polyhedrosis virus(AcNPV),a transfer vector with an immediately early gene promoter was constructed.　Methods:Transfer vector pAcPIneo which contains neomycin resistance gene(neo)coding sequence downstream of IE 1-promoter was constructed and cotransfected with the wild type of AcNPV DNA into Sf9 insect cells.Recombinant virus was selected by G418 resistance since the neo gene can be expressed in Sf9 cells.　Results:Northern blot hybridzation with 32　P labeled neo gene fragement as probe showed that the neogene was integrated in plogene of AcNPV genome.　Conclusions:Transfer vector with an immediately early gene promoter of baculovirus was constructed successfully,the neo gene was transcribed from the immediately early phase to the very late phase in infected cells.

Objective To analyze the angiography procedure,distribution of cerebral vascular lesions and complications of cerebral angiography in patients 75 years or older with cerebrovascular diseases.Methods A total of 83 consecutive patients 75 years or older (range 75-89 years) diagnosed as cerebral vascular diseases underwent cerebral angiography with a coverage of all arteries supplying blood to the whole brain including bilateral subclavian arteries between June 2003 and June 2009.The angiogram showed 61 patients (73.5%) with ischemic cerebralvascular diseases,22patients (26.5%) with hemorrhagic cerebralvascular diseases.Results The 78 (94.0%)angiographies were performed using transfemoral access.Composite curve catheters such as Simmons curve were selected in 11 (13.3%) angiographies.In patients with ischemic cerebralvascular diseases,159 stenotic lesions were detected,among which 107 (67.3%) lesions located at the anterior circulation and 52 (32.7%) lesions located at the posterior circulation;97 (61.0%) lesions were extracranial and 62 (39.0%) lesions were intracranial.The 9 unruptured aneurysms were incidentally detected in 8 patients.In patients with hemorrhagic cerebralvascular diseases,19 aneurysms were detected in 16 (72.6 % ) patients.Complications occurred in 5 (6.0 % ) patients:transient neurological complications occurred in 2 (2.4%) patients,hematoma at the puncture site occurred in 2 (2.4%)patients and uroschesis occurred in 1 (1.2%) patients.Conclusions As a kind of diagnostic technology,cerebral angiography is safe in patients 75 years or older with cerebral vascular diseases.The incidence of complications especially permanent neurological complications is low.

Objective To explore the diagnosis, treatment strategies and clinical outcomes of spontaneous subarachnoid hemorrhage in elderly patients. Methods A total of 68 patients aged over 60 years presenting with spontaneous subarachnoid hemorrhage underwent cerebral angiography. And 72 intracranial aneurysms were detected in 60 patients, among whom 47 patients with 59 aneurysms underwent endovascular coil embolization, 6 aneurysms in 6 patients were clipped in microneurosurgery operation, and 7 patients chose conservative treatment. Results A total of 57 aneurysms (96.6%) were embolized successfully, among which 40 aneurysms (70.2%) reached dense occlusion and 17 aneurysms (29.8%) reached incomplete occlusion. Among 47 patients undergoing endovascular treatment, 39 patients (83.0%) were evaluated as good, 7 patients (14.9%) were moderately to seriously disabled according to Glasgow Outcome Scale when they were discharged, and one patient died. Conclusions Active treatment such as endovascular coil embolization can acquire good outcome in elderly patients with spontaneous subarachnoid hemorrhage, especially in elderly patients detected with aneurysms.

Objective To summarize the clinical results of the surgical treatment for Stanford B aortic dissection patients with proximal aortic aneurysm(including aortic root,ascending,arch) by enblock technique.Methods From Jun.2011 to Oct.2015,20 patients with Stanford type B aortic dissection and proximal aortic aneurysm underwent open surgery by enbloc technique in our center.Among them,there were 15 male and 5 female.Average age of patients was(40.65 ± 13.55) years (range:22-65 years).The comorbidities of proximal aortic diseases are ascending aortic aneurysm in 10,aortic root aneurysm in 8,and aortic arch aneurysm in 2.All the surgeries were accomplished by hypothermic cardiopulmonary bypass assist.The combined surgery includes:extra-anatomy bypass grafting in 16,Bentall procedure in 15,ascending aortic repair in 5.Before surgery and discharged from hospital computed tomography angiography(CTA) was performed in each patient.All patients except 2 were followed.During the follow-up,CTA was performed and recorded.Results The average operation time,cardiopulmonary bypass time,aortic clamping time and selective cerebral perfusion (SCP) time are (6.47 ± 1.01)h (4.5-9 h),(173.60 ± 43.39) min (109-303 min),(91.25 ± 28.63) min (51-165 min),(27.25 ± 6.80) min (17-43 min),respectively.The mean nasopharyngeal temperature during SCP is(23.77 ± 1.27)℃ (21.6-26℃).There were no operative deaths.The mean follow-up time is (32.44 ± 17.27)months (range:8-60 months).Two patients underwent aortic re-intervention during follow-up.And 2 patients were lost follow-up(The follow-up rate is 90％).One late death was found.The patient succumbed to sudden distal aortic rupture.Other patients are survived without any complications.Conclusion Enblock technique is a relatively simple procedure in total aortic arch repair surgery.And it can be a safely surgical treatment for type B aortic dissection patients with proximal aortic aneurysm.The indications of enblock technique for Stanford B aortic dissection patients are those who combined with proximal aortic aneurysm.

Objective To investigate the clinical effect and feasibility of interventional treatment of cervical artery stenosis in the elderly patients aged 75 years and over. Methods The data of 60cases aged 75 years or over who underwent interventional treatment of the cervical arteriostenosis involving carotid artery (CA), vertebral artery (VA) or proximal segment of the subclavian artery (SCA) were analyzed retrospectively. The clinical manifestations, imaging characteristics,interventional managements and follow-up results were recorded. Results In this cohort, the mean age was (78. 9±3.7) years (range from 75 to 89). The 50 patients (93.3%) complained of cerebral ischemic symptoms, and all the patients had concurrent diseases or risk factors, including hypertension, diabetes mellitus, coronary heart disease (CHD), stroke history, and so on. Digital subtraction angiography (DSA) data showed 55 cases (91.7%) had 2 or more cerebral arteries with a stenosis exceeding 30%. Among all cases, 84 lesions were treated with 84 stents, with a technical success rate of 98.8%. After stenting, the percent diameter stenosis of lesions decreased from a mean of (80.8 ± 12.9) % to (7.1 ± 9.5 ) %. The periprocedural and 30-day postoperative neurological complication rate was 8. 3 %, resulting in a permanent complication rate of 5 %. Clinical improvement rate was 87.5%. During a follow-up period of (36.7±26. 3) months (range from 5 to 99), there were 4 deaths: 2 died from myocardial infarction, 1 died from brain metastases of lung cancer and 1 died from cerebral hemorrhage. Cerebral infarction recurred in 3 cases. Imaging follow-up in 78. 3% of patients for 66 stents, including ultrasound, CTA, MRA or DSA, showed that the general in-stent restenosis rate was 9. 1%, and the restenosis rate of VA, CA and SCA was 21.7% (5/23), 2.6%and 0, respectively. Conclusions The results of this series suggest that interventional treatment ofcervical artery stenosis in the elderly patients aged 75 years and over is effective and feasible. In our experience, clinical comprehensive management and skillful technique of the operator are equally important for the elderly patients aged 75 years and over with high incidence of concurrent diseases or risk factors.

Sodium hyaluronate is one of the natural components of articular cartilage and synovial fluid,which plays important roles in maintaining the structure and physiological functions of joints.Abnormal change of the content and physicochemical properties of sodium hyaluronate in the joints is one of the common pathological causes of osteoarthritis.Supplementation of exogenous sodium hyaluronate,which has similar physical and chemical properties as those in normal joints,has been considered as an effective strategy for clinical treatment of osteoarthritis.However,the benefits of intra-articular injection of sodium hyaluronate are still under debates.Moreover,different recommendations for clinical use were developed in several clinical guidelines.Several guidelines suggested that molecular weight of sodium hyaluronate was an important factor influencing the clinical benefits in osteoarthritis.Diverse products of sodium hyaluronate present different physicochemical and biological characteristics,which may lead to differences in clinical efficacy and safety.High-molecular-weight sodium hyaluronate,with highly modified and cross-linked sugar chains,potentially differ from those with low molecular weight in physicochemical properties,rheological characteristics,and physiological activities.In general,high-molecular-weight sodium hyaluronate have higher viscosity and elasticity.The exogenous hyaluronate,of which the molecular weight is similar to those in normal joints,probably have the similar rheological characteristics.A large number of clinical studies demonstrated that sodium hyaluronate products with high-molecular weight significantly relieved joint pain and improved joint functions in patients with osteoarthritis.In contrast,the clinical efficacy of the low-molecular-weight hyaluronate is still controversial,because several studies could not establish the superiority in osteoarthritis when comparing with the placebo.Studies on molecular mechanisms revealed that some physiological functions of sodium hyaluronate were molecular-weight dependent.High-molecular-weight sodium hyaluronate may have more pronounced impacts on the regulation of inflammation and maintaining the homeostasis of extracellular matrix.This review focused on the effects of sodium hyaluronate with different molecular weight in treating osteoarthritis.Evidence based on clinical studies related to the molecular-weight differences of sodium hyaluronate were presented.Furthermore,the optimal use of various products of sodium hyaluronate with different molecular weight was discussed.

OBJECTIVESTo assess surgical treatment of lumbar spinal stenosis associated with unstable degenerative spondylolisthesis.

METHODSIn 86 patients with lumbar spinal stenosis associated with unstable degenerative spondylolisthesis. (30 men and 56 women, aged from 30 to 77 years), 63 patients complained of lower back pain with both lower extremity pain, 10 patients pain in one leg, and 13 patients only lower back pain. Seventy-two of these patients complained of intermittent claudication, with a walking distance ranging from 10 to 1 000 m. Thirty-two patients had some changes in sensation, motion and reflexes of the foot. According to White' critera, all patients showed dynamic instability of the lesion. Meyerding criteria showed degree 1 in 79 patients, and degree 2 in 7. CT scan was made in 56 patients, MRI in 24 and MRM in 6 before operation. Myelography was performed in 61 patients, and CTM in 6. Stenosis and spondylolisthesis located between L(4) and L(5) in 49 patients, between L(3) and L(4) in 6, between L(5) and S(1) in 25, between L(3) and L(4) and between L(4) and L(5) in 2, and from L(3) to S(1) in 4. The patients with pathological spondylolisthesis were excluded. Lateral recess stenosis of one leg was observed in 10 patients, lateral recess of both legs in 22, and central canal stenosis in 54, of whom 12 patients were associated with protrusion of the lumbar disc. Decompression and autograft with iliac bone and various internal fixation were performed in all patients.

RESULTSThe patients were followed up from 8 months to 13 years, longer than 1 year (average 5.6 years) in 81 patients. According to Amundsen et al, excellent results were obtained in 78 patients, good in 5, and fair in 3. Spondylolisthesis was completely reduced in 70 patients of degree 1 (89.9%), and in 6 patients of degree 2 (85.7%). No patient showed slippage aggravated. 74 patients gained bone graft fusion within 3 months and 10 patients within 6 months. Two patients showed pseudoarthrosis during the follow-up. Complications included internal fixation breakage in 1 patient, and delayed infection in 1.

CONCLUSIONSComplete decompression and bone graft fusion are the key to treatment. Decompression and internal fixation improve the symptoms of patients with lumbar spinal stenosis associated with spondylolisthesis. Transpedicle instrumentation can reduce spondylolisthesis and maintain the physical curve of the lumbar.

Adult ; Aged ; Decompression, Surgical ; methods ; Female ; Humans ; Lumbar Vertebrae ; Male ; Middle Aged ; Retrospective Studies ; Spinal Stenosis ; complications ; surgery ; Spondylolisthesis ; surgery

OBJECTIVESTo investigate the diagnosis and treatment cervical disc calcification in children.

METHODS13 children with cervical disc calcification were analysed retrospectively. Cervical pain was observed after influenza in 5 children, suddenly cervical pain in 3, sudden wryneck in 3 cases. Two children with this disease were accidentally found after injury.

RESULTS14 calcifications of cervical disks were found in 13 children. Clinical symptoms disappeared after symptomatic management. Calcification disappeared in 5 months.

CONCLUSIONSCervical disc calcification in children is a kind of benign self-limited disease. Correst understanding of pathophysiologic course of this disease helps to avoid unnecessary surgery.

Adolescent ; Calcinosis ; diagnosis ; therapy ; Cervical Vertebrae ; pathology ; Child ; Child Health Services ; Female ; Humans ; Male

To explore a novel strategy for antisense gene therapy of cancer, the coding sequence of human proliferating cell nuclear antigen (PCNA) cDNA was reversely inserted into the eukaryotic vector pLXSN by molecular cloning techniques and transferred into bladder cancer EJ cells with liposome. The PCNA expression in transferred cells was dynamically detected by immunofluorescence and RT-PCR techniques. Changes of proliferation activities of cancer cells were assayed by MTT colorimetric and cloning formation methods. In the experiment, the antisense eukaryotic vector was successfully constructed and named as pLAPSN. After transfection with it for 1-7 days, PCNA protein and mRNA levels in cancer cells were blocked by 16.74%-84.21% (P < 0.05) and 23.27%-86.15% (P < 0.05) respectively. The proliferation activities of transferred cells were inhibited by 27.91%-62.07% (P < 0.01), with cloning formation abilities being decreased by 50.81% (P < 0.01). It was concluded that the in vitro proliferation activities of cancer cells could be effectively inhibited by blocking PCNA expression with antisense technique, which could serve as an ideal strategy for gene therapy of bladder cancer.
Cell Division ; Cell Line, Tumor ; Cloning, Molecular ; DNA, Complementary ; DNA, Neoplasm ; metabolism ; Eukaryotic Cells ; metabolism ; Gene Expression ; Genetic Vectors ; Humans ; Proliferating Cell Nuclear Antigen ; biosynthesis ; genetics ; RNA, Antisense ; genetics ; Transfection ; Urinary Bladder Neoplasms ; genetics ; metabolism