Atlanto-axial complex is the most important functional unit of the cervical spine.Atlanto-axial instability or dislocation,one of the most serious pathologies in spinal surgery,is often managed by posterior atlantoaxial fixation and fusion.Several posterior fixation techniques have been used to stabilize the atlanto-axial complex,including wire/cable-bone fixation,Halifax clamps,transarticular screw fixation,screw-plate fixation and screw-rod fixation.For atlanto-axial dislocation that cannot be reduced with skull traction before operation,intraoperative reduction is often needed.Current intraoperative reduction techniques can be classified into transoropharyngeal surgical release followed by posterior reduction and fixation,transoropharyngeal reduction and fixation,and posterior reduction and fixation using screw-rod system according to approaches.Furthermore,posterior reduction can be performed using elevating-pull,leverages,and cantilever techniques.This study reviews the intraoperative reduction and fixation techniques mentioned above.

Ample evidences have showed that the failure of early regeneration of the central nervous system(CNS) in adult mammals is mainly due to the growth inhibitory factor.Efforts have been made to promote neuron regeneration and neurological function recovery by damaging myelin and removing myelin-associated inhibitors.At present,the Nogo protein associated drugs and gene therapy have become a novel effective way to promote axon regeneration after CNS injury;here we reviews the recent progress on the related issues.

BACKGROUND: Upper cervical spine fractures are easy to lead to severe neurologic dysfunction in the elderly, and along with social progress, the incidence is on the rise. However, the diagnosis and treatment of type Ⅱ odontoid fractures in senile patients remain controversial.OBJECTIVE: To review the classification, treatment methods and clinical outcomes of type Ⅱ odontoid fractures in elderly patients.METHODS: A computer-based online search was performed in the PubMed and Wanfang databases for the articles concerning the diagnosis and treatment of type Ⅱ odontoid fractures in the elderly published from January 1996 to July 2016. The keywords were odontoid fracture, elderly, treatment, conservative, surgical in English and Chinese,respectively.RESULTS AND CONCLUSION: (1) The treatment goals of type Ⅱ odontoid fractures are different between elderly and young patients. (2) The incidence of nonunion in the conservative approach is higher than that in the surgical treatment, but for elderly patients, it makes no difference. (3) No significant differences are found in the incidence of complications and mortality between conservative and surgical methods in the elderly with type Ⅱ odontoid fractures. (4) Minimally invasive surgery is commended for the elderly suffering type Ⅱ fractures who cannot tolerate the conservative approach due to poor conditions or accompanied with other serious heart and lung diseases.

Bronchoalveolar lavage (BAL) was performed in healthy subjects (n = 12) and patients with bronchial asthma (n = ll). Between two groups there were no significant differences in total cells and percentage of alveolar macrophages (AM), lymphocytes, ncutrophils, cosinophils in BAL fluids. When AM were cultured in vitro and stimulated with dermatophagoides farinae(DPF) antigen, the quantity of PGE released by AM was significantly increased in asthmatics. When asthmatics' AM were sensitized with specific IgE positive serum and stimulated with DPF, they released more PGE, PGF2a than that when specific IgE negative serum was used (P

Articles about vertebral artery injuries secondary to blunt cervical spine trauma are increasing recently. The incidence of the disorder is reported from 19.4% to 46% in the literature. It has been found that unilate ral facet dislocations and bone fragments in the foraminal canal (comminuted fr acture of the foramen transversarium) have a significant association with the vertebral artery injuries,and that rotational violence may be a significant fac tor in causing vertebral artery occlusion. Patients with vertebral artery injuri es may have such symptoms as blurry vision, syncope, dysphagia and Wallenbergs syndrome. MRA(magnetic resonance angiography) is noninvasive and easy to per form at the time of initial MR. A routine evaluation of the extracranial circula tion with MRA should be performed as an additional sequence to all initial MR of the cervical spinal cord injury. Conventional angiography may be indicated only if the patient develops symptoms of cerebral ischemia. The benefit of antithrom botic therapy in reducing neurological morbidity and improving outcome has not y et been established and needs long-term follow-up. Operative management should be reserved only for patients with severe active bleeding or when interventiona l radiology fails. The surgical exposure is complex and demands excellent knowle dge of the local anatomy.

Objective:To investigate the molecular mechanism underlying apoptosis of lung adenocarcinoma cell line A549 induced by rapamycin, a type of mammalian target of rapamycin (mTOR) signal pathway inhibitor, combined with hypoxia treatment. Methods:Rapamycin was applied to treat A549 cell line under hypoxia for 16 h. Then the discrepancy of cell apoptosis between treated and untreated control was compared by Hochest 33258 staining. After being treated with rapamycin combined with hypoxia, the mRNA and protein expressions of survivin, a kind of anti-apoptotic molecule, were tested by real-time PCR and Western blotting. Western blotting was employed to test the difference of hypoxia-inducible factor (HIF)-1α expression level before and after rapamycin was added. In additon, chromatin immunoprecipitation(ChIP) assay was further applied to explore the mechanism underlying the effects of rapamycin under hypoxia in inducing apoptosis of A549 cells. Results:Rapamycin induced apoptosis of A549 cell line under hypxia in vitro. In A549 cell line, the expressions of survivin at mRNA (P<0.01) and protein levels, were both decreased by rapamycin combined with hypoxia treatment. Besides, ChIP assay revealed that rapamycin inhibited the expression of survivin at the transcriptional level through decreasing the hypoxia-induced up-regulation of HIF-1α and its binding with the promoter of survivin gene. Conclusion:Rapamycin exerted anti-tumor effects by inhibiting the expression of HIF-1α and decreasing the binding of HIF-1α with the promoter of survivin gene, thereby down-regulating the increase in the expression of apoptosis inhibiting gene survivin.

BACKGROUND:Previous research has demonstrated human bone marrow mesenchymal stem cells(HMSCs)differentiate into hepatocyte-like cells;however,biological characteristics and differentiation mechanism remain unclear,and differentiation system remains immature.OBJECTIVE:To investigate the feasibility of hepatocyte growth factor(HGF)and epidermal growth factor(EGF)to induce the differentiation of HMSCs into hepatocyte-like cells.METHODS:HMSC5 were obtained from patients with esophageal cancer and were separated by density gradient centrifugation combined with attachment method.The phenotypes of MSCs were identified by flow cytometry.The third-passage HMSCs were divided into four groups:HGF(adding 20 μg/L HGF),EGF(adding 20 μg/L EGF),HGF+EGF,and blank control groups.Morphology was observed using inverted microscope.At days 7 and 14 after induction,α-fetoprotein and albumin mRNA expressions were detected using RT-PCR assay.RESULTS AND CONCLUSION:The HMSCs did not express hematopoietic cell CD34 and CD35,but strongly expressed β1-integrin CD29 and matrix receptor CD44.HMSCs changed from long fusiform shape to polygon or similar round shape in the HGF,EGF,and HGF+EGF groups.At days 7 and 14 after induction,α-fetoprotein and albumin mRNA expressions were positive.However,polygon cells were not observed in the blank control group,and α-fetoprotein and albumin mRNA expressions were negative.This suggested that HGF,EGF,and HGF+EGF could induce the differentiation of HMSCs into hepatocyte-like cells;however,their differentiation ability still needs to be further semi-quantitatively analyzed using immunohistochemical staining.

Objective To analyze diagnosis and management of traumatic atlantal fractures complicated with disruption of the transverse atlantal ligament. Methods Twenty-six patients with traumatic atlantal fractures complicated with disruption of the transverse atlantal ligament, 20 acute ones and six old ones, were managed in our department from March 1995 to March 2005. All the patients had the symptom of neck pain and a certain extent of neurological deficits. The radiographic examination showed that there were fractures in the anterior arch or/and lateral mass of the atlas and that the atlanto-dental interval (ADI) in these patients was 4 to 7 mm. Twenty-one cases were operated on with occipitocervical or atlantoaxial fusion immediately after injury. Five cases received conservative treatment. Results All were followed up for 15 (from 6 to 24) months on average. The 21 cases treated operatively reported relieved symptoms. Four of the five conservative treatments succeeded, but one of them underwent a successful atlantoaxial fusion because the original conservative treatment had failed. Conclusions The severity of clinical symptoms mostly depends on the degrees of atlantal displacement and cord compression. Diagnosis should be made on the basis of the ADI change as well as clinical presentations. For patients who have potential risk of atlantoaxial instability, occipitocervical or atlantoaxial,usion should be performed early.

Objective To explore the curative effect of microsurgery via posterior approach through the sigmoid sinus in the treatment of secondary trigeminal neuralgia. Methods Clinical data of 37 cases of trigeminal neuralgia secondary to cerebellopontine angle (CPA) tumor from October 2000 to July 2006 were studied, including 18 cases of cholesteatoma, 8 cases of meningoma, 6 cases of acoustic neuroma, and 5 cases of trigeminal schwannoma. All tumors were removed with microsurgery through a posterior approach by way of the sigmoid sinus. Results A total resection was achieved in 23 cases, a subtotal resection in 10 cases, and a partial resection in 4 cases. Symptoms of neuralgia disappeared in 35 cases (including 32 cases of immediate relief and 3 cases of relief 2 months after operation). There was no improvement in 2 cases. Conclusions Microsurgery via posterior approach through the sigmoid sinus in the treatment of secondary trigeminal neuralgia is safe and effective.

[Objective]To explore the value of anterior approach in the surgical treatment of cervical fracture and dislocation.[Method]Thirty cases of lower cervical fractures and dislocations were treated with anterior decompression,reduction,autograft and plate fixation or titanic net.[Result]Patients were followed up for 6 to 24 months,the regular X-ray film to observe the stability of segmental injury and the Frankel grade to determine the recovery of the spinal cord were recorded.All cases were improved and obtained solid fusion within 3～5 months.The intervertebral heights and physiologic curves were kept well,without plate or screw complications occurring in these cases.[Conclusion]It is feasible to get complete decompression,good reduction and excellent maintenance of intervertebral heights and physiologic curves by employing anterior approach to treat lower cervical fractures and dislocations.More importantly,it can get immediate stabilization to cervical spine and prevent secondary injury to spinal cord and recover nervous function.