Objective To investigate the relationship and mechanism between the serum level of high mobility group box protein-1(HMGB1)and the mortality rate in patients with sepsis.Methods The serum levels of HMGB1,superoxide dismutase(SOD)and malondialdehyde(MDA)in 48 patients with sepsis were determined.The clinical outcomes in those patients were recorded and anlyzed.Results After the onset of sepsis,the serum HMGB1 levels of both death group and survival group were increased gradually and peaked at 72h after the onset of the disease.The semm HMGB1 levels of death group were much higher than those of survival group except at 24h(t=6.07,6.20,24.43,all P＜0.05).The activity of serum SOD of death group was markedly lower than that of survival group at 12h,24h,48h and 72h(t=10.24,20.61,11.67,33.33,all P＜0.05),and the level of serum MDA of death group was significantly higher than those of survival group at all time points(t=26.06,22.17,23.86,9.49,5.95,all P＜0.05).There was a significantly positive correlation between the serum HMGB1 and MDA level.Conlusioa The increase in serum HMGB1 level may be the important reasoll for the increased mortality rate in patients with sepsis;Oxidant/antioxidant imbalance may be olle reason for the increase in serum HMGB1 level.

Objective To establish L4 vertebrae burst fractures and take a biomechanical test of different internal fixations so as to discuss the significance of internal fixation using short-segment plus Index-level screws in treatment of low lumbar burst fractures.Methods Ten fresh human lumbosacral vertebrae specimens were used to establish models of L4 vertebrae burst fractures by corpectomy and partial removal of ligament.Thereafter,the biomechanical test was performed in order as below:longsegment fixation,short-segment fixation and short-segment construction plus Index-level screw fixation.Differences of range of motion (ROM) of the lumbar after three different internal fixations were compared.Results Compared with short-segment fixation,short-segment plus Index-level screw fixation showed that ROM of the lumbar was decreased in front flexion,axial rotation and lateral bending (P ＜ 0.05),but stability was improved and ROM of lumbar was decreased by 32.7％ in back extension (P ＞ 0.05).Conclusions Compared with short-segment fixation,the short-segment plus Index-level screw fixation can increase initial lumbar stability by average 32.5％ in treatment of low lumbar burst fractures.In the meantime,short-segment plus Index-level screw fixation provides larger ROM of the lumbar than the long-segment fixation.

Objective To evaluate the effects of posterior segmental pedicle screw instrumentation and augmentation using calcium sulphate cement in treatment of Denis type B thoracolumbar burst fractures.Methods Forty patients with Denis type B thoracolumbar burst fracture treated between January 2011 and December 2012 were reviewed retrospectively.Twenty patients received posterior short-segment pedicle screw fixation in conjunction with screw placement at the level of fracture and calcium sulphate augmentation without posterolateral fusion (combined treatment group),but 20 patients underwent traditional short-segment pedicle screw fixation (conventional treatment group).Radiographs and CT scans evaluated local kyphotic angle on the spot of injury,anterior height of the injured vertebra,and canal encroachment before and after operation and at final follow-up.Meanwhile,visual analogue score (VAS),Oswestry disability index (ODI),and neurologic status based upon ASIA 2000 were assessed.Results Mean follow-up period was 15 months (range,12-24 months).Vertebral height restoration was equivalent of the two groups immediately after operation,but better result of kyphosis correction was found in treatment group than in control group (P ＜ 0.05).Anterior vertebral height and kyphotic angle significantly improved in treatment group compared to control group at final follow-up (P ＜ 0.05).Clinical and neurologic outcome evaluation were similar between the two groups.No implant failure occurred at follow-up.Conclusion For Denis type B thoracolumbar burst fractures,posterior segmental pedicle screw fixation augmented with calcium sulphate is effective for reducing correction loss and implant failure,compensating for the deficiencies of conventional fixation.

Objective To evaluate the prognostic value of China Classification System and TNM staging in patients with liver cancer undergoing resection. Methods From Jan 1986 to Dec 2000, 246 patients underwent resection of liver cancer. At least three years of follow-up was made in these 246 cases. Results The 1, 3, 5, 7, and 10-year disease-free survival rates were 55%, 30%, 25%, 20% and 18%, respectively. The 1,3,5,7,and 10-year disease-free survival rates predicted by China Classification System and TNM staging were statistically different and positively correlated with each other. Differences of survival rate between stageⅠa、Ⅰb、Ⅱa 、Ⅱb and Ⅲ by China Classification System were all statistically significant. Conclusions Based both on tumor extension and liver function, China Classification System was more accurate in than TNM stage predicting the prognosis of liver cancer patients undergoing resection.

BACKGROUND: The development of safe and powerful antidepressant agents from traditional Chinese herbs has become a hotspot in studies on anti-depression therapy. OBJECTIVE: To investigate the anti-depressive effect and possible mechanism of curcumin by behavioral and neurochemical procedures. DESIGN: Randomized grouping design and controlled experiment. SETTING: Depart, ment of Pharmacology, School of Basic Medical Sciences of Peking University.MATERIALS: This study was carried out in the laboratory of the Department of Pharmacology, School of Basic Medical Sciences of Peking University, between November 2003 and October 2004. A total of 240 male ICR mice were recruited. METHODS: The whole experiment was divided into 4 tests. ① Antagonism of reserpine-induced hypothermia: Totally 60 mice were randomly chosen and divided into 6 groups: normal control group, groups of various doses of curcumin (1.25, 2.50, 5.00 and 10.00 mg/kg), and positive control group (imipramine 10 mg/kg). Normal temperature of the mice was measured before experiment. The animals were given a single injection of reserpine (2.5 mg/kg). The mice were administered with drugs 18 hours later, namely, curcumin of different concentrations by gastric perfusion, groundnut oil (0.1 mL/10g by gastric perfusion) as well as imipramine (10 mg/kg by intraperitoneal injection). Rectal temperature was measured 60, 90, 120,150 and 180 minutes after administration, respectively. ② Potentiation of 5-hydroxytryptophan (5-HTP)-induced head twitches: animal grouping was the same as above, and the drug in positive control group was replaced by fluoxetine. The mice received gastric perfusion and the dose of curcumin given was the same as above. Groundnut oil and fluoxetine (10 mg/kg) and 5-HTP (70 mg/kg) were injected into the vein of the tail one hour later.The number of head twitches was counted within 5-10 minutes after 5-HTP treatment. ③ Antagonism of apomorphine-induced hypothermia: Mice grouping was the same as above; the drug in positive control group was replaced by imipramine. Curcumin was give as above at 4 doses, and groundnut oil and imipramine were also given. Large-dose apomorphine was injected subcutaneously (16 mg/kg). Rectal temperature was measured before injection, as well as 30 minutes and 60 minutes after injection. ④Determination of monoamine and metabolites: Mice grouping was the same as above. The drug in positive control group was replaced by imipramine.Curcumin was give as above at 4 doses, and groundnut oil and imipramine were also given. The content of monoamine and metabolites in the mice was measured with high performance liquid chromatography. ⑤ Dunnett's t test was used for comparison between groups.MAIN OUTCOME MEASURES: ① In reserpine-induced hypothermia test, the change of body temperature before and after administration. ② In 5-HTP-induced head twitches test, whether the times of head twitches were increased. ③ In apomorphine-induced hypothermia test, the change of body temperature after administration. ④ Effect of drugs on the content of monoamine.RESULTS: Totally 240 mice entered the result analysis. ① Experiment results of reserpine-induced hypothermia: Curcumin (5 mg/kg and 10 mg/kg)produced an antagonism against reserpine-induced hypothermia, and the results were significantly different from those in control group (P ＜ 0.05,P＜0.01). Curcumin of 10.00 mg/kg produced the similar effect compared as that of imipramine in positive control group. ② Results of 5-HTPinduced head twitches: Curcumin (5 and 10 mg/kg) could significantly increase the times of 5-HTP-induced head twitches (P ＜0.05, P＜0.01). ③Results of apomorphine-induced hypothermia test: 2.50, 5.00 mg/kg and 10.00 mg/kg of curcumin could significantly increase the content of 5-HTP, and 10 mg/kg of curcumin could significantly increase the content of norepinephrine and dopamine. There was significant difference from that in control group (P ＜ 0.05). By contrast, curcumin had no obvious effect on the content of metabolite 5-hydroxyindol acetic acid and 3,4-dihydroxyphenylacetic acid. Imipramine of 10 mg/kg as the positive control drug could significantly increase the content of 5-hydroxyindol acetic acid and norepinephrine (P＜0.05).CONCLUSION: Curcumin has an antidepressant effect and the effect exerted may be related to monoaminergic neurotransmitter system.

Objective To evaluate the clinical efficacy of treatment of severe thoracolumbar burst fractures by posterior short-segment instrumentation without spinal fusion and assess radiographic imaging and function recovery after surgery.Methods Thirty-eight patients with severe monosegmental thoracolumbar burst fractures treated between July 2011 and March 2013 were analyzed retrospectively.Operation procedures were posterior short-segment pedicle screw distraction reduction and fixation combined with screw insertion to the injured vertebrae and calcium sulphate augmentation.In addition,there was no need for posterolateral interbody fusion.X-ray and CT were performed before and after operation to evaluate local kyphotic angle,anterior fractured vertebral body height and canal encroachment.Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before and after operation as well as in follow-up.Results All patients were followed up for average 14 months (range,3-20 months).Local kyphotic angle was (21.2 ±4.3)° before operation,(3.5 ± 1.8)°immediately after operation,and (4.8 ± 2.7) ° in final follow-up.Relative anterior vertebral height was (54.8 ± 14.6)％ before operation,(91.7 ± 8.0)％ after operation,and (87.2 ± 6.0)％ in final follow-up.Mean canal encroachment was (48.0 ± 4.5)％ preoperatively,(23.8 ± 7.8)％postoperatively,and (8.8 ± 4.6) ％ in final follow-up.In final follow-up,six patients with American Spinal Injury Association (ASIA) grade C on admission showed improvement to grade D (n =2) and grade E (n =4) ; 10 patients with ASIA grade E on admission showed improvement to grade E; 22 patients with grade E had no changes.ODI and VAS scored 15.5 ±8.8 and 2.3 ±0.8 in final follow-up with substantial improvement from those before operation (P ＜ 0.01).Complications from internal fixation were not found during follow-up.Conclusion Posterior short-segment fixation without fusion is one of the foremost effective methods for severe thoracolumbar burst fractures,for it can effectively restore the sagittal spinal alignment and the fractured vertebral body height.

Objective To study the role of the transforming growth factor-β-activating kinase 1 (TAK1) poly-ubiquitination in radiation-induced NF-κB activation.Methods FLAG-TAK1 and HA-UbK63 plasmids were transiently transfected into HEK-293T cells.The radiation effect on TAK1 ubiquitination was detected by immunoprecipitation and Western blot,which was further confirmed in FLAG-TAK1 HeLa stable cell line.Results At 1 h after irradiation,Lys 63-1ink TAK1 ubiquitination was induced in the HEK-293T cells with plasmids transfection.This result was further confirmed by using a FLAG-TAK1 stably expressed HeLa cell line.Radiation-induced IKKs and p38 phosphorylation were greatly impaired in MEFs reconstituted with TAK1 K158R mutant compared to ones with wild-type TAK1.Conclusions Lys63-1inked TAK1 poly-ubiquitination at Lys-58 plays a key role in the process of radiation-induced NF-κB activation.

Objective To provide a minimally invasive surgical treatment using mobile microendoscopy (mobile MED) for limited cervical spine canal stenosis. Methods Eleven patients were collected from February 2015 to February 2016 in Tianjin Hospital, including 6 males and 5 females, aged 51- 77 years, mean (67.4 ± 7.6) years. Clinical treatment was performed on 11 patients of limited cervical spinal stenosis. The levels of stenosis included C3-5 in 5 cases, C4-6 in 4 cases, C5-7 in 2 cases. The working channel of mobile MED (MMED) can be tilted according to the need of operation. The design of surgical methods:the levels of stenosis were located with fluroscopy, through a posterior median 2.5 cm incision, the nachal ligaments was separated and the spinous process was reached. After a little dissection of paraspinal mascle, the working canal was inserted along the spinous process, and the target lamina was exposed. With MMED, the partial laminectomy was performed along the junction groove of lamina and articular process with high-speed burr, and flavum was exposed and resected with ultra-thin Kerisson, and the dural sac was well exposed. Then the working canal was inserted on the contralateral side along the spinous process, and the decompression was performed with the same method. After bilateral direct decompression, the spinous process and posterior ligament complex shift posteriorly with enlargement of spinal canal. The operation time and blood loss were recorded and the efficacy was followed-up. Results There was no serious complications such as neurological injury. The operation time ranged 80-120 min, with an average of (100 ± 18) min. The intraoperative blood loss ranged (50-120) mL, with an average of (80 ± 20) mL. Postoperative CT showed sufficient decompression and enlargement of the canal with the posterior shift of the spinous process and posterior ligament complex. The patients were followed up for 6-18 months. The alignment of cervical spine was well preserved on X-ray. The ODI decreased from 42.2 ± 16.3 preoperatively to 6.2 ± 4.3. The JOA score improved from 8.2 ± 3.3 preoperatively to 15.1 ± 4.2 at the last follow-up. According to the improvement rate [(JOA-preoperative JOA)/(17-preoperative JOA)], the results were excellent in 5 cases, good in 5 cases, and effective in 1 case. Conclusion The cervical canal enlargement with mobile microendoscopic discectomy technique preserving posterior ligament composite provides a minimally invasive procedure for limited cervical stenosis with adequate decompression.

Objective To explore the value of quantitative T2 weighted magnetic resonance imaging (T2WI) and diffusion tensor imaging (DTI) parameters for predicting functional outcomes after surgery for cervical spondylotic myelopathy (CSM).Methods One hundred and forty CSM patients received T2WI and DTI before surgery at Tianjin Hospital between April 2014 and April 2016.They were then given systematic rehabilitation treatment after the surgery.The Japanese Orthopaedics Association (JOA) scoring system was applied to evaluate their neurological function before and after the surgery.According to the JOA recovery rate at 1-year follow-up,the patients were divided into a good recovery group (recovery rate≥ 50％) and a poor recovery group (recovery rate ＜50％).Maximum spinal cord compression (MSCC),signal change ratio (SCR),transverse area (TA),apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were compared between the two groups.Receiver operating characteristics (ROC) curves were used to measure the prognostic ability and determine the best cut-off value for each variable.The independent predictors of a poor recovery were estimated using univariate and multivariate analysis.Results ROC analysis showed that the area under the ROC curve (AUC) of MSCC was 0.593.For SCR it was 0.682.For the TA it was 0.706.For the ADC it was 0.719 and for FA it was 0.749.The respective cut-off values were 44％ compression,1.561,0.46 cm2,1.339×10-3 mm2/s and 0.386.FA had the largest AUC,followed by ADC,TA,SCR and MSCC.MSCC and SCR had low discrimination power (AUC＜0.7) in predicting a poor recovery,whereas TA,ADC and FA had moderate discrimination power (AUC 0.7-0.9).Logistic multivariate regression showed that a low JOA score,TA≤0.46 cm2 or FA≤0.386 were independent risk factors for a poor recovery.A predicting model built according to the results of the logistic regression analysis gave an AUC of 0.87,significantly better than that of the JOA score.With a cut-off value of 0.36,the sensitivity and specificity were 80％ and 77％ respectively.Conclusions Combining T2WI and DTI parameters with the JOA score may better predict the recovery of patients with CSM.The values can also provide references for making up rehabilitation plans.

Objective To observe the clinical efficacy of transcranial direct current stimulation (tDCS) in the treatment of pain after lumbar fusion operation. Methods Patients underwent lumbar fusion surgery in the Department of Minimally Invasive Spine Surgery, Tianjin Hospital from January 2016 to December 2016 were retrospective analyzed. They were divided into tDCS group and control group according to the postoperative analgesic strategies. Patients in tDCS group were given flurbiprofen injection combined with tDCS to control postoperative pain, and morphine was used if necessary. The control group was only given flurbiprofen injection combined with morphine analgesia to manage postoperative pain. The data of preoperative and postoperative pain visual analogue score (VAS), oswestry disability index (ODI), opioid analgesics usage and complications before and after operation were recorded. Results Forty-two patients were included in this study. There were 22 patients in tDCS group with the mean age (56.7±10.5) years, and 20 in control group with the mean age (60.3± 9.2) years. There were no significant differences in preoperative VAS and ODI scores between two groups. The VAS and ODI scores at postoperative 24 h and hospital discharge significantly improved in two groups compared with preoperative data. Data of postoperative 24 h VAS score (2.0 ± 1.7), VAS score (2.1 ± 0.9) and ODI score (20.9 ± 6.5) at hospital discharge were significantly lower in tDCS group than those in control group (3.3 ± 1.4, 2.9 ± 1.3 and 25.4 ± 5.3). The dosage of opioid medication use in controlling postoperative pain was reduced about 25％ in tDCS group (P < 0.01). The complications reported in tDCS group included itching under the electrodes, pain, scorching hot and stinging. Conclusion The use of tDCS after lumbar fusion operation can decrease the pain sensation, reduce the usage of opioids, promote the rehabilitation and with no increasing the incidence of related complications, which has the potential probability to replace opioids for chronic pain.