[Objective]To study the pathogenesis of lumbar degenerative spondylolisthesis(LDS)through the degeneration degree of lumbar facet joints and the changes of the joint sagittal angle of little zygapophysial joints and the endplate hypozygal angle in patients with LDS and lumbar disc herniation (LDH).[Methods]The image data of 79 patients with lumbar degenerative diseases were collected from October 2009 to November 2011.There were 42 patients with L4-5 LDS(experimental group)and 37 patients in same age with L4-5 LDH(control group).The L4-5 facet joints were graded by Weishaupt ect.lumbar facet joint osteoarthritis imaging grading method.The joint sagittal angle of L4-5 little zygapophysial joints and the L4endplate hypozygal angle were detected by CT.The L4-5 facet joint osteoarthritis grading,joint sagittal angle of lumbar little zygapophysial joints,L4 endplate hypozygal angle and bilateral symmetry between two groups were compared.[Results]There was no grade 0 of facet joint osteoarthritis in both two groups.The numbers of grade 1,2,3 in experimental group were 4,20,18 cases,respectively,while the numbers in control group were 21,14,2 cases.There was significant difference between the numbers of two groups(P ＜ 0.05).The joint sagittal angle of L4-5 little zygapophysial joint,deviation angle of sagittal angle asymmetry and L endphtehypozygal angle in experimental group(26.62°± 1.67°,8.79°± 4.28°,116.92±6.86°)had statistical significance compared with those in control group(45.07° ± 7.32°,5.14° ± 4.28°,104.95° ± 4.97°)(P ＜0.01).The deviation angle of endplate hypozygal angle asymmetry in experimental group had no statistical significance compared with that in control group(P ＞ 0.05).[Conclusions] The sagittal orientation of lumbar facet joint angle and the endplate hypozygal angle increasing have important significance in LDS.

Objective To master the prevalence of H unan Immunodeficiency Virus (HIV),hepatitis C virus (HCV)and syphilis (RPR)infection and influencing faictors in Liucheng County,Guangxi Province,provided scientific basis for reducing the infection rate among drug users.Methods Analysis of 2011-2015 surveillance data of AIDS sentinel population.Results Male infection is more than female.The ratio of male to female is 1:0.072;The number of male infected with 2011-2015 in each year is 10 times that of female.The affect people between 20 to49 years old was higher than that of others,accounted for 93.66 ％ of the total number of infections.The ntmber of HIV and the number of HCV were downgrade year by year.The number of RPR was at the same level each year.HIV infection between 20 to 29 years old was lower than that of between 30 to 39 and 40 to 49 years old in HIV-infected people.HIV infection between 30 to 39 years old was lower than that of between 4(to 49 years old.The difference was statistically significant(P＜0.01).HCV infection between 20 to 29 years old was lower than that of between 30 to 39 and 40 to 49 and 50 to 59 years old in HCV-infected people.The difference was statistically significant(P＜0.01).RPR infection between 20 to 29 years olt was lower than that of between 30 to 39 and 40 to 49 years old in RPR-infected people.The difference was statistically significant(P＜0.01).Conclusion To strengthen the detection of drug users and behavior intervention,reduce the harm of AIDS,protect the health and safety of the people,is an important way to curb the prevalence of AIDS.

Objective To study the characteristics of spinal fractures in ankylosing spondylitis(AS) in order to provide data in its diagnosis and treatment. Methods 19 cases of concomitant spinal fractures following AS, admitted in our hospital between January 1994 and October 2001, were studied retrospectively. Examination of AS, including A-P and lateral X-ray films of bilateral sacroiliac joint, HLA-B27, rheumatoid test and ESR were accomplished in all patients. MRI and CT scan were taken in 12 cases. 4 cases of thoracolumbar stress fracture treated surgically were conformed to pathological examination. 2 cases received preoperative puncture biopsy under CT guidance. In the group, there were 18 males and 1 female aging from 31 to 69 years with an average of 52.6 years. Results All of 19 cases were consistent with the diagnostic standards of AS. 17 of the patients prior to spinal fracture had a history of AS with duration of mean 20.6 years ranging from 8 to 37 years. All of 19 patients had round-backed deformity of different extent. Of 19 patients, 15 cases had a traumatic history. Falls while standing and walking were the cause of injury in 9 patients. The mechanism of injury appeared to be hyperextension in 7. 11 patients had the cervical fracture, and 8 had the thoracolumbar fracture. Of the patients with cervical fracture, 10 patients were due to shearing force, 9 of whom were located at C5-C7. In patients with thoracolumbar injury, stress fractures were seen in 7 patients, all of seven fractures occurred at T10-L2. Fracture through ankylosed disc was seen in 12 and vertebral body in 7. 16 of the 19 patients sustained fractures through three columns of the spine. 5 patients were associated with dislocation. 9 patients had spinal cord injury, 8 of whom were cervical fracture. The period from the injury to the diagnosis ranged from 10 hours to 7 months (mean 29.6 days). Conclusion Spinal fractures in AS can result from a mild trauma, and are associated with a high rate of neurological injury. Most frequent mechanism of the injury is hyperextension. Shearing fracture usually occurs at the lower cervical spine and stress fracture at thoracolumbar spine. Most of the fractures involve three columns of spine; and corresponding dislocation is common. The common fracture line is through the disc space. Delay in diagnosis is not rare.

Objective To investigate the effects of different magnitudes of mechanical stress on human interverte-bral disc degeneration. Methods The human intervertebral disc cells were subjected to different magnitudes of mechanical stress (0, 6%, 12%, or 18%elongation) for 24 h using a Flexercell Strain Unit. The mRNA expressions of anabolic genes (col-lagen-1A1, collagen-2A1, aggrecan and versican) and catabolic genes (MMP-3, MMP-13, ADAMTS-4 and ADAMTS-5) were examined by real-time PCR and Western blot methods. Results The expression levels of collagen-1A1 and collagen-2A1 were increased at 12%of mechanical stress, and collagen-2A1 was decreased at 18%of mechanical stress compared with those of control. The mRNA expressions of catabolic genes, MMP-13 and ADAMTS-5, were increased at 12%and 18%of mechanical stress than those of control. The mechanical stretch induced a magnitude-dependent increase in ADAMTS-4 synthesis, which was finely tuned by stretching-triggered activation of distinct mitogen-activated protein kinase cascades. Specifically, an ERK1/2 specific inhibitor, U0126, significantly inhibited the stretching-induced ADAMTS-4 expression, whereas the inhibitors of p38 and JNK, SP6000125 and SB203580, showed only slightly effect on the stretching-induced ADAMTS-4 expression. Conclusion The different magnitudes of mechanical stretch exhibited different effects on the bio-logical behavior of intervertebral disc cells, which profoundly affects the intervertebral disc degeneration.

Objective To observe the adipocytic differentiation potential of bone marrow stromal cells (BMS), and the effect of simvastatin on adipocytic differentiation of bone marrow stromal cells in vitro, and to elucidate the mechanisms of anabolic effect of simvastatin on bone formation. Methods BMS from femur and tibia of adult female BALB C mice were cultured in vitro. Changes of alkaline phosphatase (ALP) activity were determined after treatment with adipogenetic agonist (hydrocortisone 0 5 ?mol/L and indomethacin 60 ?mol/L, HI) for 6 days. Thenexpression of lipoprotein lipase (LPL) mRNA was detected by RT PCR after treatment with HI and different concentration of simvastatin for 72 h. Adipogenetic differentiation were also observed with Oil Red O staining and fluorescence activated cell sorting (FACS) after treatment with HI and different concentration of simvastatin or 100 ?g/L rhBMP 2 for 12 days. Results After BMS were treated with HI for 6 days, ALP activity was significantly decreased ( P

Objective: To observe the effect of simvastatin on osteoblastic cell differentiation of bone marrow stromal cells in vitro, and to elucidate the mechanisms of anabolic effect of simvastatin on bone formation. Methods: Bone marrow stromal cells from femur and tibia of adult female BALB C mice were cultured in vitro , after being treated with different concentrations of simvastatin for 72 h, changes of mRNA level of osteocalcin (OCN) were detected by RT PCR, change of OCN, and osteopontin (OPN) expression were examined by Western blot, and the changes of cellular alkaline phosphatase activity (ALP) were examined by histochemistry and enzymologic measurement. Results: After bone marrow stromal cells were treated with different concentration of simvastatin for 72 h, level of OCN mRNA increased, and expression of OCN and OPN also increased in a concentration dependent manner, and cellular ALP activity significantly increased in a concentration dependent manner. Conclusion: Simvastatin can stimulate osteoblastic differentiation,and improve cellular ALPase activity with high expression of osteocalcin and osteopontin in vitro. These may be parts of the mechanism of anabolic effect of simvastatin on bone formation.

Objective To evaluate the feasibility,safety and efficacy of surgical treatment of the thoracic and thoracolumbar disc herniations through the posterior far lateral approach,Methods From April 2005 to June 2010,24 consecutive patients with thoracic or thoracolumbar disc herniations were treated surgically,using the posterior far lateral approach.There were 15 males and 9 females with the mean age of 53.6 years old(range,25-69 years).The levels of herniated discs were located in T4-s,T5-6,T6-7 for 1 case,in T9-10 for 1 case,in T10-11 for 2 cases,in T10-11,T11-12,T12L1 for 1 case,in T11-12 for 3 eases,in T11-12,T12L1 for 3 cases,in T12L1 for 4 cases,in T12L1,L1-2 for 3 cases,and in L1-2 for 6 eases.There were one level disc herniation in 16 cases,two levels disc herniation in 6 cases and three levels disc herniation in 2 cases.16 out of 24 cases had "bony protrusions",including bony separation of the endplate,bony spur,disc calcification or OPLL.The average preoperative Cobb angle of localized kyphosis was 10.5°.According to the Frankel grading system,5 cases were classified as C,16 as D,and 3 as E,preoperatively.Results Average operation time was 3.5 h(2.0-4.5 h),and mean blood loss was 800 ml(300-4000 ml).Postoperative localized kyphosis was an average of 4.6°,with average correction rate of 56.2%.24 cases were followed up for 1 to 62 months,with an average of 18 months.According to Japanese Orthopaedic Association(JOA)criteria system,there were 12 cases(50.0%)with excellent outcome,9 cases(37.5%)with good outcome,and 3 cases(12.5%)with fair outcome.The postoperative Frankel grading were C for 1 case,D for 2 cases,and E for 21 cases.There were no complications intraoperatively and postoperatively.The symptoms were improved in all patients.Conclusion By using "safe triangular zone" and dekyphosis stabilization,the posterior far lateral approach was a relatively safe,reliable,effective and better view surgical procedure for the treatment of the thoracic and thoracolumbar disc herniations.

Objective To investigate the safety and efficiency of thoracic laminectomy with dekyphosis for thoracic myelopathy due to multi-segmental ossification of the posterior ligaments.Methods The clinical data of five cases of thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments who were surgically treated in our hospital between August 2012 and March 2013 were retrospectively analyzed,among which two were male and the other three were female,with an average age of 52 (range,45-56) years old.The pre-operative duration ranged from 2 months to 6 years.All five cases were suffering from progressive bilateral partial paraplegia with an average preoperative JOA score 3.8 (range,3-6),an average segment-number of ossification of the posterior ligaments 7.6 (range,5-10),and also an average segment-number of 5.0 (range,2-10) ossification of the ligamentum flavum.All the five cases showed different kyphosis at the stenotic area of thoracic spine,with an average kyphotic angle (Cobb) of 35.8° (range,22°-56°).Their pre-operative Japanese Orthopaedic Association score (JOA) was 3.8 averagely (range,3-6).Clinical features,operation time,blood loss,perioperative complications and postoperative outcome were recorded.Results The segment number of laminectomy of these five cases was 8.2 averagely.The segment number of dekyphosis was 2 for 2 cases and 1 for the other 3 cases,with a average dekyphotic degree of 7.8° (range,2°-15°).The average operation time was 6.3 hours (range,5.5-7.0 hours) and the average blood loss was 3900 ml.The perioperative complications included cerebrospinal fluid leakage in 4 cases who were treated conservatively,and epidural hematoma in 1 case who underwent reoperation for removing the hematoma.All cases were followed up for 21 to 27 months,and their average final JOA score was 10,with an average recovery rate of 85.6％,and a rate of excellent or good was 100％ by the modified Epstein standard.Conclusion The result of thoracic laminectomy combined with dekyphosis for thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments is quite satisfying,however this procedure is demanding with a long operation time,a huge blood loss and a high complication rate.

Eye Diseases ; prevention & control ; Home Care Services ; Humans ; Schools ; Single-Blind Method ; Students ; Urban Population

STUDY DESIGN: A retrospective clinical review. PURPOSE: To investigate the difference in clinical manifestations and severity between polymicrobial and monomicrobial infections after spinal surgery. OVERVIEW OF LITERATURE: Surgical site infections (SSIs) after spinal surgery are a major diagnostic and therapeutic challenge for spinal surgeons. Polymicrobial infections after spinal surgery seem to result in poorer outcomes than monomicrobial infections because of complementary resistance to antibiotics. However, comparison of the clinical manifestations and severity between polymicrobial and monomicrobial infections are limited. METHODS: Sixty-seven patients with SSIs after spinal surgery were studied: 20 patients with polymicrobial infections and 47 with monomicrobial infections. Pathogenic bacteria identified were counted and classified. Age, sex, and body mass index were compared between the two groups to identify homogeneity. The groups were compared for clinical manifestations by surgical site, postoperative time to infection, infection site, incisional drainage, incisional swelling, incisional pain, neurological signs, temperature, white blood cell count, and the percentage of neutrophils. Finally, the groups were compared for severity by hospital stay, number of rehospitalizations, number of debridements, duration of antibiotics administration, number of antibiotics administered, and implant removal. RESULTS: Polymicrobial infections comprised 29.9% of SSIs after spinal surgery, and most polymicrobial infections (70.0%) were caused by two species of bacteria only. There was no difference between the groups in terms of clinical manifestations and severity. In total, 96 bacterial strains were isolated from the spinal wounds: 60 strains were gram-positive and 36 were gram-negative pathogenic bacteria. Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Enterobacter cloacae were cultured in order of the frequency of appearance. CONCLUSIONS: Most polymicrobial infections were caused by two bacterial species after spinal surgery. There was no difference in clinical manifestations or severity between polymicrobial and monomicrobial infections.
Anti-Bacterial Agents ; Bacteria ; Body Mass Index ; Coinfection ; Debridement ; Drainage ; Enterobacter cloacae ; Escherichia coli ; Humans ; Length of Stay ; Leukocyte Count ; Neutrophils ; Postoperative Complications ; Retrospective Studies* ; Spine ; Staphylococcus aureus ; Staphylococcus epidermidis ; Surgeons ; Surgical Wound Infection ; Wounds and Injuries