Objective To determine the relation between the graduation and type of Modic change and low back pain. Methods Ninety-seven patients with low back pain associated with Modic change were enrolled, and the data of clinical were analyzed. The degree of back pain was evaluated by visual analog score (VAS) and Oswestry disability index (ODI). The relation between Modic change and the degree of low back pain was evaluated. Results In 97 patients, the type of Modic change:28 cases (28.9%) were type Ⅰ, 37 cases (38.1%) were type Ⅱ, 11 cases (11.3%) were Ⅱ/Ⅲ, and 21 cases (21.6%) were type Ⅲ. The graduation of Modic change:39 cases (40.2%) were minimal, 34 cases (35.1%) were moderate, and 24 cases (24.7%) were severe. The VAS of type Ⅰ, type Ⅱ, typeⅡ/Ⅲand typeⅢin patients with Modic change were (3.8 ± 0.4), (2.6 ± 0.2), (1.7 ± 0.5) and (1.0 ± 0.6) scores, and there were statistical differences (P<0.05). The ODI scores of type Ⅰ, type Ⅱ, type Ⅱ/Ⅲ and type Ⅲ in patients with Modic change were (11.8 ± 0.7), (8.4 ± 1.1), (5.7 ± 1.3) and (2.0 ± 1.0) scores, and there were statistical differences (P<0.05). Spearman correlation analysis result showed that the type of Modic change was negatively correlated with the intensity of low back pain (r=-0.342, P<0.01). There were no statistical difference in VAS and ODI score among the patients with minimal, moderate and severe of Modic change (P>0.05). Spearman correlation analysis result showed that the graduation of Modic change had no correlation with the intensity of low back pain (r = 0.351, P>0.05). Conclusions The graduation of Modic change does not directly correlate with the low back pain, but the type of Modic lesion is more important.

Objective To discuss the surgical effect of adult lipomatous tethered cord syndrome (TCS). Methods The clinical data of 29 patients with adult lipomatous TCS were systematically analyzed. Eleven of male and 18 of female,who ranged from 20 to 59 years. All patients were performed filum terminale release and lipoma excision, the clinical outcome after operation was analyzed according to Hoffman grading criteria and visual analog scale (VAS). Results According to Hoffman grading criteria, 9 cases were obviously improved in leg muscle weakness, including 1 case with urination disturbance improved significantly. Also the lower back pain of patients were improved obviously: (2.63 ± 1.30) scores vs. (8.67±0.30) scores, there was significant difference (P<0.05). Conclusions Filum terminale release and lipoma excision can effectively improve the symptom of lower back pain of adult lipomatous TCS patients, meanwhile the symptom of paraparesis can improve appropriate postoperatively. But urinary deficits do not show a significant change.

Objective The aim of the experiment is to make an intracranial aneurysm model in canine.Methods A digital tube was made based on raw magnetic resonance images of the human intracraaial carotid artery.Then 6 tubes were made in the 3 D rapid prototyping machine and coated with silicone.Finally we isolated the common carotid arteries of 6 canines and made them go through the tubes and anastomosed them end-to-side to get the aneurysm model.Six stents were implanted after one week.Results Six aneurysm models were successfully made in canines.The parent artery had similar geometrv of the human carotid siphon.All the aneurysms and parent arteries were patent in one week's follow-up.One canine died of excessive anesthesia after stentingr Two vaseular models kept patent in one month without stenosis.The other 3 had some stenosis on the bends of the vessel.Conclusions The aneurysm model in tIle experiment has high flexibility and reliability.The model provides an effective tool for research and testing neurovascular devices.It's also a useful device to train the neuroradiologists and interventional physicians.

Objective To explore the effect of iliac artery to deep femoral artery angioplasty on the improvement of postoperative lower limb ischemic symptoms and recovery in patients with lower limb arteriosclerosis obliterans(LEASO).Methods One hundred and four LEASO patients in Dongzhimen Hospital of Beijing University of Chinese Medicine from December 2013 to July 2016 were involved in the study and they were divided into control group and observation group according to the treatment program,each group 52 cases.The control group was treated with conservative treatment,and the observation group was treated with iliac artery to deep femoral artery angioplasty.After treatment,the limb ischemic injury degree Rutherford classification and clinical efficacy of the two groups were compared,all patients were followed up for 6 months to compare the survival quality score before and 6-month after treatment.Results (1) Rutherford classification: after treatment,Rutherford classification in the observation group was significantly higher than that of the control group,the result was statistically significant (Z=2.160,P=0.031);(2) Clinical efficacy: the total effective rate in the observation group (94.23% (49/52)) was higher than that of the control group (76.92% (40/52)),the difference was statistically significant (χ2=6.310,P=0.012);(3) Life quality: before treatment,there was no significant difference between the two groups in terms of the quality of life score ((55.01±6.32) points vs.(54.89±6.14) points,t=0.098,P=0.922),but 6 months after treatment,the score of the observation group became higher than that of the control group ((69.63±7.51) points vs.(63.15±6.98) points,t=4.558,P=0.000).Conclusion The treatment of LEASO using iliac artery to deep femoral artery angioplasty can effectively improve patient''s lower limb ischemic symptoms and life quality.

Objective To determine the association of gallstone,cholecystectomy and colorectal cancer.Methods From 2000 through 2007,a historical cohort study was carried out in the check analysis of the cumulative incidence of colorectal cancer of 3809 gallstone patients who had had cholecystectomies (cholecystectomy sub-group),1764 gallstone patients who had not had cholecystectomies(noncholecystectomy sub-group)and 8187 nongallstone patients(control group)were also included in the analysis of the incidence of colorectal cancer.Results(1)The cumulative incidence of colorectal cancer of the gall-stone group was 0.43 ％(24/5573)while that of the control group was 0.13 ％(11/8187)(x2 =11.879,P =0.001).(2)The cumulative incidence of colorectal cancer in cholecystectomy sub-group was 0.45％(17/3890)while that of the non-cholecystectomy sub-group was 0.40％(7/1764)(x2=0.069,P =0.793).(3)The cumulative incidence of colorectal cancer was 0.23％(8/3467)in gallstone patients with a conrse ＜ 15 years,while that was 0.76％(16/2106)when the course ≥ 15 years(x2 =8.550,P =0.003).(4)Serum triglyceride level elevated in 20.83％(5/24)colorectal cancer cases of gallstone group,however serum triglyceride level elevated only in 5.86％(325/5549)of gallstone group with non-colorectal cancer cases(x2 =9.621,P =0.002).(5)The incidence of colorectal cancer in gallstone group was not related to gender,age,overweight,hypertension,diabetes mellitus and dysfunction of liver(x2 =1.444,P =0.229;x2=7.833,P=0.251;x2 =1.151,P=0.283;x2 =0.797,P=0.372;x2 =0.939,P=0.332;x2 =2.103,P =0.147).(6)The ratio of rectal cancer,right colonic cancer,left colonic cancer and multifocal carcinoma were 41％(10/24),38％(9/24),17％(4/24)and4％(1/24),respectively.Conclusions Gallstone is a high risk factor of colorectal cancer irrespective of whether or not a cholecystectomy is carried out.Over fifteen-years course of gallstone and hypertriglyceridemia significantly increases the risk of the colorectal cancer in gallstone patients.The incidence of rectal cancer and right colonic cancer is more frequently seen in gallstone related colorectal cancer.

Objective:To compare the clinical efficacy between puncture assisted by a "TINAVI" orthopaedic robot versus freehand puncture in vertebroplaty for osteoporotic vertebral compression fracture(OVCF) of the upper thoracic vertebra.Methods:A retrospective study was conducted of the 19 patients (20 vertebral bodies) with OVCF of the upper thoracic vertebra who had been treated at Department of Spine Surgery, Honghui Hospital from January 2018 to March 2019 by robotic vertebroplasty (robot group) and of another 21 counterpart patients (21 vertebral bodies) who had been treated by conventional vertebroplasty from January 2016 to December 2017 (freehand group). Puncture was conducted by a "TINAVI" orthopaedic robot in the robotic vertebroplasty but freehand in the conventional vertebroplasty. The robot group had 5 males and 14 females, aged from 62 to 88 years; the freehand group had 6 males and 15 females, aged from 64 to 83 years. The 2 groups were compared in terms of operation time, bone cement volume, postoperative complications (cement leakage, infection and embolism), visual analogue scale (VAS), Oswestry disability index (ODI), anterior height (AH) and kyphosis angulation (KA) of the injured vertebra at day 1 and last follow-up after surgery.Results:The 2 groups were comparable because there were no significant differences between them in the preoperative general data ( P>0.05). Vertebroplasty via unilateral puncture approach was completed uneventfully in the 19 patients (20 vertebral bodies) in the robot group and in the 21 patients (21 vertebral bodies) in the freehand group. The 40 patients were followed up for 6 to 12 months (mean, 8.3 month). The operation time [(37.9±8.2) min], bone cement volume [(2.3±0.9) mL] and rate of cement leakage (10.0%, 2/20) in the robot group were all significantly less or lower than those in the freehand group [(46.2±9.4) min, (4.2±1.3) mL and 42.9% (9/21)] ( P<0.05). No infection or embolism was observed in either group. There were no significant differences between the 2 groups in VAS, ODI, AH or KA of the injured vertebra at day 1 or last follow-up after surgery ( P>0.05). Conclusion:In vertebroplaty for OVCF of the upper thoracic vertebra, compared with conventional freehand puncture, puncture assisted by a "TINAVI" orthopaedic robot can lead to satisfactory clinical efficacy because it reduces operation time, volume of bone cement injection, and thus incidence of bone cement leakage.

Objective To acknowledge the NALP3 inflammasome expression and significance in the interstitial cystitis/bladder pain syndrome (IC/PBS).Methods The urine of 16 IC/BPS patients and 16 normal persons was collected to measure the IL-1β content by ELISA.Bladder tissue of 16 IC/BPS patients and para-carcinoma tissue of 16 bladder cancer patients were collected.And the levels of NALP3,caspase1 and IL-1β were detected by Western Blot.60 female rats were randomly divided into control group(bladder was infused with 0.5 ml saline),hyaluronidase group [bladder was infused with 0.5 ml hyaluronidase (4 mg/ml)],NALP3 antagonist group [bladder was infused with 0.5 ml hyaluronidase (4 mg/ml) and Glyburide(10 mg/kg)] and mucosal protectant group [bladder was infused with 0.5 ml hyaluronidase (4 mg/ml) and sodium hyaluronate(0.8 mg/ml)] to carried out the animal experiment,and 15 rats in each group.The models were created by long-term (1 month) intermittent intravesical hyaluronidase infusion.Voiding patterns were investigated by cystometry.Toluidine blue staining was used to detected mast cell’s changes.The levels of NALP3,caspase-1 and IL-1β were determined by Western Blot,HE staining was to detect tissue inflammation of the bladder,and the severity of pain was examined by Von-frey brush by using the strength of 0.07、0.4、1.0 g.The comparison between the chemotaxis of 200 ng,400 ng IL-1β and 200ng SCF IL-1β to mast cells was checked by Transwell experiment.Results The expressions of IL-1β in IC/PBS patients was increased in IC/PBS group than normal control group [(381 ± 112) μg/L vs.(98 ± 40) μg/L,P ＜0.01].The expressions of NALP3,Caspase-1 and IL-lβ had increased in the IC/PBS group than normal group(0.22 ±0.08 vs.0.11 ±0.02,0.25 ±0.03 vs.0.10 ±0.01,0.19 ±0.04 vs.0.11 ± 0.02,P ＜ 0.05)by Western Blot.In the IC/PBS rats,compared with the control group,the intercontraction intervals [(120.0 ± 15.6) s vs.(447.3 ± 24.6) s] and bladder capacity [(0.34 ± 0.02) ml vs.(1.33 ± 0.04) ml] of the model group were significantly decreased (both P ＜ 0.05).In mucosal protectant group and NALP3 antagonist group,the intercontraction intervals [(323 ± 16.3)s,(280 ± 12.5)s] and bladder capacity [(1.14 ± 0.05) ml,(0.84 ± 0.04) ml] were increased compared with control group (P ＜ 0.05).The amount of mast cell in model group were significantly increased than control group (3.4 ±0.8 vs.0.4 ± 0.2,P ＜ 0.05) while in mucosal protectant group (1.8 ± 0.5) and NALP3 antagonist group (1.5 ± 0.7) were decreased compared with control group (P ＜ 0.05).The protein levels in modle group of NALP3 (5.91 ±0.33 vs.1.00 ±0.12),caspase-1 (6.75 ±0.42 vs.1.00 ±0.22) and IL-1β(7.12 ±0.45 vs.1.00 ± 0.18)were increased than control group.In mucosal protectant group and NALP3 antagonist group,theNALP3 (2.921 ±0.21,2.07±0.18),caspase-1 (3.28 ±0.31,2.25 ±0.19) and IL-1β(3.33± 0.41,1.98 ±0.21) were decreased compared with control group.VonFrey pain score in model group were significantly increased than control group(0.07 g:7.5 ± 1.8 vs.2.1 ± 0.5,0.4 g:9.2 ± 1.9 vs.5.2 ± 1.1,1.0g:15.4±3.8 vs.6.8±1.5,P＜0.05) and VonFrey pain score(0.07 g:2.4±0.3,2.8± 0.7;0.4 g:5.2 ±0.4,6.5 ±1.3;1.0 g:6.4 ±0.8,7.3 ±1.1;P＜0.05) in NALP3 antagonist group were significantly decreased.In vitro,Transwell experimental results showed that 400 ng IL-1β of mast cell chemotaxis is similar with that of the 200 ng SCF (3 800 ±400 vs.4 800 ±500,P ＞0.05).Conclusions The levels of NALP3/Caspase-1/IL-1β in the urine of patients with IC/PBS were significantly higher than those in normal control group.NALP3 is activated in chronic cystitis rat model,and related to pain and frequent urination.This may be related to the down-regulation of expression of NALP3,caspase-1,IL-1β,and other inflammatory mediators,and blocking the chemotactic effects of IL-1 β on mast cells.

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 explore the effect of calcium phosphate cement（CPC）scaffold loaded with emodin（EMO）on osteogenic activity of osteoblasts.Methods:The bone cement scaffold was prepared by mixing EMO powder and CPC powder（ratio 1∶9），adding citric acid and then was poured into polytetrafluoroethylene mold（EMO-CPC group）. A dose of 0.36 g CPC powder was mixed with citric acid and injected into the polytetrafluoroethylene mold（CPC group）. General morphology，setting time（initial setting time and final setting time），injection rate and compressive strength of stents were compared between the two groups. Primary osteoblasts were extracted and co-cultured with two sets of scaffolds. After co-culture for 3 days，their characterization was observed by scanning electron microscopy. Live/dead cell staining and 3-（4,5-dimethylthiazole-2）-2,5-diphenyltetrazolium bromide（MTT）colorimetric method were used to detect cell viability，toxicity and proliferation activity of scaffolds. Two sets of scaffolds were stained with immunofluorescence for osteopontin（OPN），and protein expression was observed under an inverted fluorescence microscope. After co-culture for 7 days，tetrazolium nitro blue/5-bromo-4-chloro- 3-indolyl-phosphate（NBT/BCIP）staining method was used for alkaline phosphatase（ALP）staining. After co-culture for 14 days，two sets of scaffolds were stained with Alizarin Red to detect their osteogenic activity.Results:Two sets of stents showed relatively smooth and flat topography under the scanning electron microscope. There were no significant differences in initial setting time，final setting time，injection rate and compressive strength of stents between two groups（ P > 0.05）. After co-culture for 3 days，the osteoblast clusters were adhered to the surface of the EMO-CPC scaffold，with good shape. Viable cell rate reached（98.2 ± 0.1）% in EMO-CPC group and（90.2% ± 0.1）% in CPC group（ P <0.05）. Cell proliferation activity in EMO-CPC group was stronger than that in CPC group（ P < 0.05）. OPN-specific staining showed that EMO-CPC group had stronger OPN protein fluorescence expression compared to CPC group. After co-culture for 7 days，expression of ALP in EMO-CPC group was higher than that in CPC group. After co-culture for 14 days，staining intensity of Alizarin Red in EMO-CPC group was more significant than that in CPC group. Conclusions:The EMO-CPC scaffold can provide a suitable environment for the growth of osteoblasts for it has better biocompatibility，cell proliferation and osteogenic activity than the CPC scaffold.

Objective:To investigate the long-term efficacy of self-designed posterior atlas polyaxial screw-plate in the treatment of unstable atlas fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 20 patients with unstable atlas fracture who were admitted to Affiliated Honghui Hospital of Xi′an Jiaotong University from January 2011 to April 2013, including 14 males and 6 females, aged 23-60 years [(42.7±8.6)years]. All the patients were treated with internal fixation using self-designed posterior atlas polyaxial screw-plate. The operation time and intraoperative bleeding volume were recorded. The fracture reduction was evaluated by CT scan at 3 days after surgery. The bone healing was observed by X-ray (anterior-posterior and lateral views of the cervical spine) and CT scan at 9 months after surgery. The delayed spinal cord injuries were evaluated by Frankel grade at 1 and 2 years after surgery and at the last follow-up. The Visual Analogue Scale (VAS) before surgery, at 3 months, 1 year, 2 years after surgery and at the last follow-up were compared. The axial rotation, flexion and extension range of the cervical spine at 3 months, 1 year, 2 years after surgery and at the last follow-up were compared. Intraoperative and postoperative complications were observed.Results:All the patients were followed up for 121-148 months [(135.0±6.8)months]. The operation duration was 68-122 minutes [(86.0±14.1)minutes], with the intraoperative blood loss of 90-400 ml [(120.0±67.9)ml]. The CT scan of the cervical spine at 3 days after surgery showed all satisfactory fracture reduction. Satisfactory bone reunion was observed at 9 months after surgery. All patients were scaled as Frankel grade E at 1 year, 2 years and at the last follow-up after surgery, with no delayed spinal cord injuries observed. The VAS scores of the cervical spine at 3 months, 1 year, 2 years after surgery and at the last follow-up were 2.0(1.3, 3.0)points, 1.0(1.0, 1.8)points, 1.0(0.3, 1.0)points and 1.0(0.3, 1.0)points, which were significantly lower than that before surgery [7.0(6.0, 7.8)points] ( P<0.05), with significantly lower scores at 1-, 2-year after surgeny and at the last follow-up than at 3 months after surgery ( P<0.05). There were no significant differences among the other time points ( P>0.05). The axial rotation ranges of the cervical spine were (103.0±8.3)°, (128.3± 11.4)° and (129.8±13.6)° at 1 year, 2 years after surgery and at the last follow-up respectively, which were significantly higher than that at 3 months after surgery [(85.3±7.0)°] ( P<0.05); It was further improved at 2 years after surgery and at the last follow-up compared with that at 1 year after surgery ( P<0.05), with no significant difference at the last follow-up compared with that at 2 years after surgery ( P>0.05). The flexion and extension range of the cervical spine at 1 year, 2 years after surgery and at the last follow-up were (65.5±4.8)°, (78.3±6.5)° and (79.3±6.9)° respectively, which were significantly higher than that at 3 months after surgery [(54.3±4.4)°] ( P<0.05); It was further improved at 2 years after surgery and at the last follow-up compared with that at 1 year after surgery ( P<0.05), with no significant difference between the last follow-up and 2 years after surgery ( P>0.05). No intraoperative injuries such as arteriovenous injury were observed. No incision infection or dehiscence occurred after surgery, with no complications caused by long-term bed rest such as lung or urinary tract infection, pressure sore formation or deep vein thrombosis occurred. No loosening or breakage of the screw and atlas plate was observed at the long-term follow-up. One patient had mild cervical pain, snap during rotation, and limited range of motion at the last follow-up. Conclusion:Self-designed posterior atlas polyaxial screw-plate has merits including small surgical wounds, satisfactory reduction, solid fixation, obvious pain relief, effective preservation of the previous cervical motion, few complications, and satisfactory long-term efficacy in the treatment of unstable atlas fracture.