Objective To discuss the efficacy of alprostadil and levocarnitine in treatment of chronic renal failure combined with heart failure.Methods Totally 80 patients with chronic renal failure complicated with heart failure were selected,and randomly divided into two groups.The control group (39 cases) was given alprostadil.The observation group (41 cases) was given alprostadil and levocarnitine.The efficacy of alprostadil and levocamitine in treatment of chronic renal failure combined with heart failure was evaluated by cardiac fimction indexes,renal function indexes,SF-36 scale score,and adverse reaction during the treatment.Results Before treatment,there was no statistical significance on CO,CI,MVO,and EF between two groups.After treatment,the CO,CI,and MVO were decreased and lower in the observation group (P ＜ 0.05).The EF was increased in the observation group and higher than that of the control group (P ＜ 0.05).The EF had no changes in the control group.Before treatment,there was no statistical significance on CysC,BUN,and SCr between two groups before treatment,without statistical significance.After treatment,CysC,BUN,and SCr were decreased in two groups and lower in the observation group (P ＜ 0.05).Before treatment,there was no statistical significance on SF-36 scores between two groups.After treatment,the physiological function,physical function,and general health were higher than those of the control group (P ＜ 0.05).There was no statistical significance on the rest of the scores.During treatment,there was no statistical significance on adverse reaction between two groups.Conclusion Alprostadil and levocarnitine had a good curative effect on chronic renal failure combined with heart failure.It could improve the heart function by reducing cardiac load,improve the renal function by increasing glomerular filtration rate and improve the quality of life with good safety.It is worthy of clinical application.

Objective To explore the method for measuring and calculating both absorbed dose and effective dose received in organ and tissues of occupational workers by using TLDs for the implantation of 125Ⅰ seed sources.Methods The experiments with 60Co γ-rays were carried out for the stability.A group of TLD chips was exposed to 125Ⅰ seed sources to establish standard dose curve for air kerma.During the 125Ⅰ seed implantation, the TLD chips were pasted to 13 locations like thyroid inside and outside the lead aprons worn by occupational workers to measure average absorbed dose and calculate the absorbed doses and effectives to organs and tissues.Results For 3 cases of prostate cancers with implantation of 125Ⅰ seeds, the worker's organs and tissues received the absorbed dose 0.02 -3.80 μ Gy and effective dose 0.06- 1.81 μSv outside lead aprons and the highest absorbed dose 2.35 μ Gy and effective 0.02 μSv inside lead aprons, respectively, with more than 65.9% of rays shielded.For 3 cases of brain cancers with implantation of 125Ⅰ seeds, the workers received the absorbed dose 0.23 - 11.31 μGy and effective dose 0.88 - 4.07 μSv outside lead aprons and the highest absorbed dose 2.22 μ Gy and effective dose 0.09 μSv inside lead aprons, respectively, with more than 54.5% of rays shielded.For 3 cases of lung cancers with implantation of 125Ⅰ seeds, the workers received the absorbed dose 0.03 - 14.78 μGy and effective dose 0.35 -7.59 μSv outside lead aprons and the highest absorbed dose 4.09 μGy and effective 0.22 μSv inside lead aprons, respectively, with more than 58.4% of rays shielded.For 2 cases of mediastinum cancers with implantation of 125Ⅰseeds, the workers received the absorbed dose 0.06 - 74.91 μGy and effective dose 0.83 - 17.96 μSv outside lead aprons and the highest absorbed dose 10.29 μGy and effective 0.5 μSv inside lead aprons, respectively, with more than 85% of rays shielded.For one case of ovary cancer with implantation of 125Ⅰ seeds, the worker received the absorbed dose 0.09 - 14.29 μGy and effective dose 2.40 - 4.50 μSv outside lead aprons and the highest absorbed dose 7.77 μGy and effective 0.12 μSv inside lead aprons, respectively, with more than 34% of rays shielded.For one case of eye cancer with implantation of 125Ⅰ seeds, the workers received the absorbed dose 2.2 -39.84 μGy and effective dose 4.48 - 10.06 μSv outside aprons and the highest absorbed dose 5.19 μGy and effective 0.16 μSv inside aprons, respectively, with more than 54.6 % of rays shielded.Conclusions The method of using TLDs to measure the doses to the occupational workers in the course of the implantation of 125Ⅰ seed sources is simple and easy to operate.It would be an effective approach to protecting medical workers in the case of brachytherapy.

Sacral fractures are usually caused by high-energy violence,often complicated with injury to the lumbosacral plexus.In severe cases,they may cause instability of the posterior pelvic ring or of the lumbosacral junction.Their classifications commonly used in clinic are Denis,Tile,Isler and refined Denis type Ⅲ ones proposed by Roy-Camille and Gibbons.Recently,classifications of the lumbosacral lesions and scoring systems of the injury severity have often been used clinically.At present,internal instrumentation of sacral fractures is developing along the direction of high efficiency,safety and minimal invasion,but different methods of internal fixation have their own indications which should be strictly followed.This review summarizes the classifications of sacral fractures and their treatment advances.

Objective To determine the clinical efficacy of limited internal fixation with posterior titanium plates for unstable atlas fractures.Methods A retrospective case series analysis was performed for 29 patients with unstable atlas fractures immobilized using the posterior titanium plate from January 2011 to November 2014.There were 22 males and seven females,with a mean age of 41.5 years (range,17-68 years).Ten patients were diagnosed with 1/2 ring Jefferson fractures,12 anterior 1/2 Jefferson fractures and seven patients posterior 3/4 Jefferson fractures.Frankel neurological performance scale was grade E in all patients.Operation time,amount of bleeding during operation and postoperative complications were recorded.X-ray and CT were performed to identify the fusion,internal fixation location and atlantoaxial stability.Visual Analogue Scale (VAS) for craniocervical pain and cervical range of motion were evaluated.Results Mean duration of procedure was (86.6 ± 7.8) min (range,68-122 min) and mean blood loss was (120.0 ± 25.3) ml (range,90-400 ml).No vascular and neurologic complications were noted.All patients were followed up for (22.5 ± 18.0)months (range,12-32 months).CT scans confirmed bony union in all patients 6 months after operation.No plate-related complications,implant lessening and implant breakage occurred during the follow-up.Postoperative VAS [(1.9 ± 1.1) points] was significantly lower than that before operation [(7.2 ± 1.4) points] (P ＜ 0.05).At the last follow-up,the ranges of cervical flexion-extension [(81.3 ± 22.2) °] and rotation [(152.4 ±38.7) °] were close to the normal range.Conclusion Limited internal fixation with posterior titanium plates is a safe and effective surgical method that contributes to good reduction and maximal preservation of cervical physiological motion.

Objective To investigate the correlation factors for surgical outcome of sacral decompression and lumbopelvic fixation in H-shaped sacral fracture and the methods to prevent and treat the complications.Methods From January 2008 to January 2016,45 patients with H-shaped sacral fracture treated by sacral decompression and lumbopelvic fixation were respectively analyzed,including 29 men and 16 women,mean age 41.2 (range,24-53 years),mean follow-up time 52.6 months (range,16-93 months).The surgical outcome was evaluated by pelvic outcome score,and correlation factors were analyzed.We analyzed whether each factor was in correlation with pelvic outcome score.Then we integrated the statistically significant indicators into Logistic regression equation to determine the related factors.Postoperative complications were all recorded.Results The average operation time was 161.2 min (range,100-220 min),average blood loss was 491.6 ml (range,370-1 000 ml),injury-surgery interval was 7.2 d (range,1-23 d).In terms of pelvic outcome score,31 (68.9％) patients had satisfactory result and 14 (31.3％) patients had unsatisfactory result.Univariate x2 analysis suggested that cauda equina injury,Roy-Camille classification,L5S1 facet injury,fracture line,kyphotic angle,injury-surgery interval,decompression approach and inserting sacral screws were correlated with pelvic outcome score,but gender,age,injury mechanism and L5 pedicle fracture had no relation with pelvic outcome score.The multivariate Logistic regression analysis showed that cauda equina injury,Roy-Camille classification,fracture line,kyphotic angle,injury-surgery interval,decompression approach and inserting sacral screws were closely related to pelvic outcome score,but L5S1 facet injury was excluded.2 patients required early surgical procedures with proper antibiotics for deep wound infection;3 patients complained pain related to hardware prominence and the pain subsided after removal of implants;1 patient got unilateral rod breakage at 3-6 months and achieved bony fusion after nine months of observation.Conclusion Sacral decompression and lumbopelvic fixation is effective in neurological recovery and early ambulation in treating H-shaped sacral fracture.Better surgical outcome is related to timely surgery,preoperative or intraoperative bone traction,sacral screws insertion,incomplete cauda equina injury,Roy-Camille type Ⅱ,fracture line penetrating S2 and kyphotic angle less than 40°.

Objective To evaluate the feasibility of using gelatin sponge to reduce bone cement leakage in percutaneous vertebroplasty (PVP).Methods A retrospective case control study was conducted to analyze the 191 patients (191 vertebrae) with lumbar osteoporosis vertebrae compression fractures (OVCF) who were treated by PVP from October 2014 to October 2017 in Xi'an Honghui Hospital.There were 52 males and 139 females,aged 65-91 years,with an average of 75.1 years.A total of 48 patients were treated with routine PVP,and bone cement was injected directly after puncture (Group A).A total of 47 patients,49 patients and 47 patients were injected with 1/4,1/3 and 1/2 gelatin sponge before bone cement injection respectively (Group B,Group C and Group D).Postoperative routine X-ray and CT scans were used to compare the amount of bone cement injection,the leakage of bone cement,the visual analogue score (VAS),neurological symptoms and complications before and after operation.Results All patients were followed up for 1-12 months,with an average of 3.6 months.There were no significant differences in the amount of bone cement injection after operation between groups (P ＞ 0.05).There was a significant difference in the cement leakage rate among the groups after operation [Group A:42％ (20/48);Group B:40％ (19/47);Group C:14％ (7/49);Group D:13％ (6/47)] (P ＜ 0.05).The results of pairwise comparison of bone cement leakage rate were as follows:significant differences were found between Group A and Group C as well as between Group A and Group D (P ＜ 0.008 3),but no significant difference was found between Group A and Group B (P ＞ 0.008 3);significant differences were found between Group B and Group C as well as between Group B and Group D (P ＜ 0.008 3),but no significant difference was found between Group C and Group D (P ＞ 0.05).There were no significant differences in VAS among the groups (P ＞ 0.05);VAS was significantly improved after operation within each group (P ＜ 0.05).After operation,two patients had persistent lower back pain and one patient had intraspinal leakage.Wound healing was found in all patients,with no neurological symptoms.Conclusion For OVCF,use of 1/3 or 1/2 gelatin sponge in PVP can reduce bone cement leakage.

Objective To investigate the effect of bone morphogenetic protein 2 (BMP2)on ossification of the posterior longitudinal ligament (OPLL) and its relationship with transforming growth factor-3 (TGF-3)/Smad signaling pathway.Methods The expression vectors of wild type pcDNA3.1-BMP2 (WT),mutant pcDNA3.1-BMP2 (37G),mutant pcDNA3.1-BMP2 (190T) and mutant pcDNA3.1-BMP2 (37G/190T) were constructed and identified by agarose gel electrophoresis.The constructed vector was transfected into mouse embryonic fibroblasts C3H10T1/2 mediated by liposome to detect the expression of BMP2.Six groups were divided according to the transfection situation:(1) the non-transfection group;(2) empty vector pcDNA3.1 transfection group;(3) pcDNA3.1-bmp2 (WT)transfection group;(4) pcDNA3.1-bmp2 (37G) transfection group;(5) pcDNA3.1-bmp2 (190T)transfection group;(6) pcDNA3.1-bmp2 (37G/190T) transfection group.The experimental and control group were defined according to whether BMP2 polymorphism was included.Therefore,the nontransfection group and empty vector pcDNA3.1 transfection group were control groups,and the other groups were experimental groups.The expression of phosphorylated Smad1/5/8 and Smad4 in positive cell clones were detected by western blotting,and the alkaline phosphatase (ALP) was detected by quantitative detection kits.The protein expressions were compared among the experimental groups.Results Two fragments digested from pcDNA3.1-BMP2 represented 1.2 kb and 5.4 kb by agarose electrophoresis.The direct sequencing results were in accordance with target gene sequence.BMP2 gene was successfully transfected and stably expressed in C3H10T1/2 cells.Western blotting showed that the expression of phosphorylated Smad1/5/8 protein in the experimental groups was increased significantly after transfection,with significant difference between the experimental groups and the control groups (P ＜0.05),but without significant differences among the experimental groups (P ＞ 0.05).The expressions of Smad4 protein transfected by wild or mutation type pcDNA3.1-BMP2 were significantly higher than those in the control groups (P ＜ 0.05),and the expressions of Smad4 protein transfected by pcDNA3.1-BMP2(37G) and pcDNA3.1-BMP2 (37G/190T) were significantly higher than those in the other experimental groups (P＜0.05).The ALP activity results of experimental groups transfected by pcDNA3.1-BMP2 (37G) and pcDNA3.1-BMP2 (37 G/190T) were (30.56 ± 0.46) nmol · min-1 ·mg-1 and (29.62 ±0.68)nmol · min-1 · mg-1,with no significant difference between the two groups (P ＞0.05).However,there were significant differences between the two groups and other experimental groups (P ＜0.05).The Ser37Ala (T/G) polymorphism in exon 2 of BMP2 gene was positively correlated with ALP activity in stably transfected C3H10T1/2 cells.Conclusion The Ser37Ma (T/G) polymorphism in exon 2 of BMP2 gene promotes OPLL ossification through TGF-β/Smad signaling pathway,the possible mechanism for which is to up-regulate the protein expressions of Smad4 and ALP.

With the large use of vertebral augmentation in the treatment of osteoporotic thoracolumbar fracture (OTLF), the complication of cement leakage has become an increasing concern. Although most cement leakage has no obvious clinical symptoms, some patients still sustain serious complications such as vertebral fracture, pulmonary embolism and spinal nerve compression. Cement leakage is closely related to patients′ own factors, cement factors and perioperative related factors. To clarify the risk factors of cement leakage with implementation of preventive measures accordingly is of great guiding significance to improve the clinical efficacy and surgical safety. Therefore, the authors discuss bone cement leakage in aspects of the risk factors and preventive measures so as to provide a reference for reducing the incidence of cement leakage.

Objective To evaluate the precise percutaneous sacroplasty (PSP) assisted by a Renaissance robot for sacral insufficiency fractures (SIF).Methods The clinical data of 12 SIF patients were retrospectively analyzed who had been treated from March 2016 to March 2018 at Department of Spinal Surgery,Honghui Hospital.They were 5 males and 7 females,aged from 55 to 76 years (average,67.5 years).They all received PSP assisted by a Renaissance robot.Their operation time,hospital stay and intraoperative radiation were recorded.The clinical efficacy was evaluated by comparing their visual analogue scale (VAS) and Oswestry disability index (ODI) before surgery,1 day,3 and 12 months after surgery.Results All the 12 patients underwent surgery successfully with no complications like cement leakage.Their operation time ranged from 32 to 47 minutes (mean,36.8 minutes),their hospital stay from 12 to 25 hours (mean 17.5 hours) and their intraoperative exposure to radiation from 0.87 to 1.53 mSv (mean,1.27 mSv).All the patients were followed up for 12 to 18 months (mean,15.8 months).Their VAS (1.7 ± 0.7) and ODI (22.8 ± 4.1) one day after surgery were significantly decreased than the preoperative values (7.6 ±0.9 and 43.7 ±4.6) (P ＜ 0.05).At 3 and 12 months after surgery,their VAS scores were 2.0 ± 0.8 and 2.4 ±0.8 and their ODI scores 21.5 ±4.3 and 23.0 ±4.6,respectively,showing no significant differences from the values at 1 day after surgery (P ＞ 0.05).Conclusion The PSP assisted by a Renaissance robot is safe and leads to satisfactory clinical efficacy for SIF as bone cement can be accurately injected into the target area of the fracture.

Objective:To discuss the curative effect between direct decompression and indirect decompression plus lumbo-iliac fixation for treatment of Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury.Methods:A retrospective case-control study was performed on clinical data of 47 patients with Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine from March 2012 to March 2017. All patients underwent lumbo-iliac internal fixation. The operation time ranged from 3 to 14 days after injury, with an average of 6 days. In direct decompression group ( n=26), the sacral foramina mass was removed during the operation and direct decompression was performed. There were 16 males and 10 females, with age of (36.2±8.4)years. In indirect decompression group ( n=21), indirect decompression through traction and distraction was performed. There were 11 males and 10 females, with the age of (38.7±9.8)years. Operation time, intraoperative blood loss, bone union, Mears imaging evaluation, Gibbons score, and Majeed function score were compared between the two groups. Postoperative complications were observed as well. Results:All patients were followed up for 1233 months, with an average of 16.7 months. The operation time and intraoperative blood loss in direct decompression group were (112.3±26.3)minutes and (512.1±29.4)ml, which had no significant differences in comparison with that in indirect decompression group [(129.3±25.1)minutes and (529.7±22.1)ml] ( P>0.05). Bone union was observed in all patients. According to the Mears imaging evaluation, the direct decompression group had anatomical reduction in 17 patients, and satisfactory reduction in 9, and the indirect decompression group had anatomical reduction in 15 patients and satisfactory reduction in 6 ( P>0.05). At the last follow-up, Gibbons score in direct decompression group was lower than that in the indirect decompression group [(1.2±0.3)points vs. (2.2±0.5)points] ( P<0.01); Majeed function score in direct decompression group was higher than that in indirect decompression group [(87.3±11.4)points vs. (68.5±16.7)points] ( P<0.01). In direct decompression group, 1 patient had deep wound infection, while in indirect decompression group, 1 patient had pressure sore due to the protrusion of the tail of the iliac screws on the skin. Conclusion:For Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury, direct decompression with lumbo-iliac fixation can obtain better neural functional recovery and functional recovery of life compared with the indirect decompression.