Objective To compare the incidence of secondary surgical procedures after cervical disc arthroplasty vs anterior cervical discectomy with fusion in patients treated for symptomatic single level cervical spondylosis.Methods An online search of Pubmed, Medline, Ovid, Embase, Cochrane Library, CBM database, Wanfang data and VIP database were searched for prospective randomized controlled trial of cervical disc arthroplasty versus anterior cervical discectomy with fusion in incidence of secondary surgical procedures.Data were collected and extracted by two reviewers independently.Risk of bias was assessed using the criteria of Cochrane Reviews Handbook 5.1.0.Review Manager 5.2 software system was used to evaluate the data for Meta analysis.Results A total of 12 trials were included.Six of them were short-term follow up (two years).The 6 other trials were mid-and long-term follow up (mean 5.8 years).There are 4 trials with low risk of bias, 7 trials with moderate risk of bias, and 1 trial with high risk of bias.The results of meta-analysis showed there was no statistical difference in reoperation rate of adjacent level between the two groups at two years follow-up;however, the reoperation rate of non-fusion group was significantly lower in the non-fusion group compared with fusion group at mid-and long-term follow-up.The incidence of secondary surgical procedures at index level was higher in fusion group than in non-fusion group.No statistical difference was found between the two groups in using ‘ removal’ for secondary surgical procedure at two years follow-up;however, the rate of non-fusion group was significantly lower than fusion group at mid-and long-term follow-up.Conclusion Cervical disc arthroplasty was partly superior to anterior cervical discectomy with fusion in avoiding secondary surgical procedures of adjacent levels.However, non-fusion surgery doesn't have any advantages in short time (two years) follow up.Reducing the incidence of pseudarthrosis was an effective way to decrease the incidence of secondary surgery procedures in index level.

Objective To investigate the protective effects of simvastatin on cobalt choride ( CoCl2 ) -induced hypoxia and reoxygenation injury on alveolar type Ⅱ cells and the underlying mechanisms.Methods CoCl2 was used to establish the hypoxia and reoxygenation injury model on AT Ⅱ cells.Blank,control and variant doses simvastatin-treated groups ( 5,10,20,30,50,100 μ mol/L) were designed in the present study.The proliferation of AT Ⅱ cells was evaluated by Cell Counting Kit-8 ( CCK-8 ) assay.The percentage of apoptotic cells was assessed by flow cytometry AV/PI double-staining.The protein levels of surfactant protein-C (SP-C) and proliferating cell nuclear antigen (PCNA) in AT Ⅱ cells was determined by Western blot.Results As compared with the control group,pretreatment with low dose (5 - 20 μmol/L),but not high dose simvastatin (50 - 100 μmol/L) markedly reduced A549 cells apoptosis,and increased their proliferation and the protein levels of SPC and PCNAin vitro.The protective effect could be reversed in vitro by L-mevalonate,a simvastatin competitive inhibitor,which indicated that the inhibition of mevalorate pathway was involved in the simvastatin induced AT Ⅱ cells function restoration.Condusion Low doses simvastatin reversed CoCl2-induced hypoxia and reoxygenation injury of AT Ⅱ cells.The inhibition of mevalonate pathway contributed to simvastatin induced AT Ⅱ cells function restoration.

ObjectiveTo compare the incidence of C5 nerve palsy after laminoplasty and laminectomy with internal fixation for treating multilevel cervical spondylotic myelopathy (MCSM).MethodsFrom January 2005 to June 2010,68 patients with MCSM were treated with laminoplasty (27 patients,group A) or laminectomy with internal fixation(41 patients,group B).There were 21 males and 6 females in group A,aged 33-80 years(average,60.4 years),31 males and 10 females in group B,aged 22-77 years (average,58.7 years).All the patients were followed up for 12-48 months (average,22 months).In both groups,Cobb's method was applied to measure cervical lordotic angle,and Ishihara's method was conducted to measure cervical curvature index(CCI) before and after operation.The incidence of C5 nerve palsy was recorded and compared.Then we further compared preoperative and postoperative the cervical lordosis angle and CCI of 9 patients with C5 nerve palsy (group B1) and 32 patients without C5 nerve palsy (group B2) in group B.ResultsThe incidence of C5 nerve palsy in group A was 3.7％(1/27),while 22.0％(9/41) in group B (x2=4.32,P＜0.05).For all ten patients with C5 nerve palsy,the muscle strengths of paralyzed muscles were recovered to grade 4 or better after being treated with conservative treatment for an average of 14 months.The change rate of preoperative and postoperative CCI in group B1 was 38.07％±18.03％,while 22.81％±12.71％ in group B2.There was a statistical difference between group B1 and group B2 (t=2.88,P＜0.05).Conclusion Compared with laminoplasty,laminectomy with internal fixation has a higher incidence of C5 nerve palsy.The C5 nerve palsy may be associated with postoperative increase of cervical lordosis angle.Moreover,tethering of the C5 root may be one of its important pathomechanisms.

Objective To detect mutations in the PTPN11 gene in a family with LEOPARD syndrome (LS).Methods Clinical data were collected from a 7-year-old boy patient with LS.Peripheral blood was obtained from the patient,both of his parents,and 50 healthy controls.All the exons and their flanking sequences of the PTPN11 gene were amplified by PCR followed by direct DNA sequencing.Results A heterozygous missense mutation c.836A ＞ G,which resulted in a substitution of TAT by TGT at codon 279,was found in exon 7 of the PTPN11 gene in the patient.No mutation was detected in the unaffected parents or healthy controls.Conclusion The missense mutation c.836A ＞ G may be the cause of the phenotype of LS in this family.

ObjectiveWe evaluate our experience of previously blocking both pulmonary artery and veins in true video assisted thoracic surgery (VATS) for the treatment of non-small-cell lung carcinoma ( NSCLC ).MethodsSix patients undergoing lobectomy with previously blocking both pulmonary artery and veins in the VATS in our institution between December 2007 and June 2011 were reviewed.ResultsIn our series,six patients required previously blocking both pulmonary artery and veins in the VATS,The mean occlusion time of PA and PV was (42.0 ± 8.6 ) min and ( 39.3 ± 8.2 ) min,respectively.Four patients required partial PA reconstruction.The mean repair time of the PA was (21.25 ±9.91 ) min.No complications attributable to the technique or mortality were seen.There were no local recurrences on the pulmonary artery.ConclusionIt is feasible and safe that the technology of previously blocking of the pulmonary artery and veins was applied in VATS.This technique can reduce the risk of intraoperative bleeding and the chance of converting to open thoracotomy,and extend the inclusion criteria of VATS lobectomy.

OBJECTIVE: To construct short hairpin RNA interfering expression vector of TDRG1,and detect the specific interfering effect of TDRG1-shRNA expression vector on NTERA-2 cells. METHODS: Oligos for short hairpin RNA targefing for TDRG1 were designed and connected to the expression vector pGPU6/GFP/Neo to construct the TDRG1 shRNA expression vector. The recombinant plasmid TDRG1-shRNA486, TDRG1-shRNA738, TDRG1-shRNA921 and lipofectamine ™2000 were used to generate and transfect shRNA into NTERA-2 cells. Expression of TDRG1 mRNA was assayed by RT-PCR. RESULTS: TDRG1-shRNA expression vector was successfully constructed. TDRG1-shRNA486 was more effective in the suppression of TDRG1 with significant reduction of TDRG1 mRNA. CONCLUSION TDRG1-shRNA can interfere the expression of TDRG1 in NTERA-2 cells.
Cell Line, Tumor ; Genetic Vectors ; Humans ; RNA Interference ; RNA, Messenger ; RNA, Small Interfering ; Transfection

Objective:To investigate mutations in the KRT5 gene in a pedigree with Dowling-Degos disease.Methods:Clinical data were collected from the proband, and a survey was conducted in 12 members in 3 generations of the family. Peripheral blood samples were obtained from the proband, 8 family members and 50 unrelated healthy individuals, genomic DNA was extracted for whole-exome sequencing, and sequencing results were compared with the published sequences of human KRT5, POFUT1 and POGLUT1 genes.Results:There were 3 patients in this family, including the proband, his father and deceased grandmother. The proband and his father clinically presented with reticular pigmentation in the skinfolds, especially the chest and abdomen skinfolds. A novel heterozygous nonsense mutation c.165T>A was identified in exon 1 of the KRT5 gene in the proband and his father, but not in other family members or healthy controls. No abnormality was found in the POFUT1 or POGLUT1 gene in any subjects.Conclusion:A novel heterozygous nonsense mutation c.165T>A was identified in the KRT5 gene, and may contribute to the clinical phenotype of the proband and his father with Dowling-Degos disease.

Objective:To investigate the clinical significance of intraoperative prepositioning of dual mediastinal drains in elderly patients developing anastomotic leakage(AL)after a total endoscopic Ivor-Lewis procedure.Methods:This retrospective case-control study analyzed the clinical data of 500 elderly patients who underwent total endoscopic Ivor-Lewis surgery for esophageal or cardia cancer from January 2020 to December 2022.In the control group, one mediastinal drainage tube was placed intraoperatively, while in the study group, two mediastinal drainage tubes were placed.Both groups had a chest tube placed conventionally.The study compared the incidence of anastomotic leak(AL)at 1 month postoperatively, inflammatory indexes in patients with AL, grading of AL, rate of nasal fistula placement, incision infection, anastomotic stenosis, and incidence of hoarseness.Additionally, it compared ICU occupancy, ventilator use, and ICU length of stay between the two groups.Results:The analysis included clinical data from 455 elderly patients.Among the patients who developed AL, the study group had significantly lower peak body temperature[(39.58±1.03)℃ vs.(38.05±0.56)℃, t=4.298, P<0.05], white blood cell count[(18.63±3.35)×10 9/L vs.(14.28±2.78)×10 9/L, t=3.450, P<0.05], and C-reactive protein(CRP)levels[(154.66±41.64)mg/L vs.(122.19±31.29)mg/L, t=2.131, P<0.05]. The study group also had a significantly lower grading of AL and rate of nasal fistula placement(82.4% vs.30.0%, P<0.05). In terms of ICU indicators, the study group had a significantly lower ICU admission rate(64.7% vs.10.0%, P<0.05), shorter period of ventilator use[(6.47±8.15)days vs.(0.90±2.23)days, t=2.62, P<0.05], and shorter ICU stay[(11.70±8.89)days vs.(4.70±6.27)days, t=2.184, P<0.05]. Conclusions:Double mediastinal drainage tubes, have been found to significantly alleviate inflammation, decrease the rate of nasal fistula placement and ICU admission, and shorten the length of ICU stay in elderly patients.Therefore, they are considered safe and deserving of clinical promotion.

Background Programmed necrosis is closely related to the occurrence and development of neurodegenerative diseases, but whether lead causes programmed cell necrosis has not been reported. Objective This experiment is designed to probe into the function of programmed necrosis and the effect of its inhibitor on lead-induced microglia (BV2 cell) injury. Methods The BV2 cells at logarithmic growth phase were treated with 0, 1, 5, 10, 25, 50, 100, and 200 μmol·L⁻¹ lead acetate for 12, 24, 36, and 48 h, respectively, and methylthiazolyldiphenyl-tetrazolium bromide (MTT) was used to determine cell viability. After treatment with 0, 25, 50, and 100 μmol·L⁻¹ lead acetate for 24 h, enzyme-linked immunosorbent assay, Western blotting, and flow cytometry were used to determine the expressions of tumor necrosis factor-α (TNF-α), receptor-interacting protein kinase 3 (RIPK3), receptor-interacting protein kinase 1 (RIPK1), and mixed lineage kinase domain-like protein (MLKL) in the cells, and the effect of RIPK1 inhibitor Nec-1 pretreatment on lead-induced BV2 cell injury . Results The BV2 cell viability decreased with higher lead concentration (r_{12 h}=−0.995, r_{24 h}=−0.984, r_{36 h}=−0.983, r_{48 h}=−0.981, all P<0.01) and time extension (only for 5 μmol·L⁻¹ lead acetate, r=−0.994, P<0.01). Compared with the control group, the BV2 cell viability decreased at the same exposure time when the concentration of lead was above 10 μmol·L⁻¹ (P<0.01). Compared with the control group, the expressions of RIPK1 and MLKL were increased in the 25, 50, and 100 μmol·L⁻¹ lead groups (P<0.05 or 0.01), accompanied by an increase in the contents of inflammatory cytokine TNF-α, especially in the 100 μmol·L⁻¹ lead group, the increment was the highest (P<0.01). The expression levels of p-RIPK1 and p-MLKL in BV2 cells were both increased when the concentration of lead acetate was above 50 μmol·L⁻¹ (P<0.01). In addition, pretreatment with Nec-1 increased the cell viability rate and decreased the necrosis and late apoptosis rate of BV2 cells exposed to lead compared with corresponding lead exposure groups (P<0.05). Conclusions Lead can reduce BV2 cell viability, increase necrosis rate, and up-regulate the expressions of RIPK1, RIPK3, amd MLKL, and the phosphorylation levels of RIPK1 and MLKL. The RIPK1 inhibitor Nec-1 has an intervention effect on lead-induced damage in BV2 cells, indicating that programmed necrosis may play a role in lead neurotoxicity.

OBJECTIVE: To investigate the toxic effects of nano-sized neodymium oxide( nano-Nd_2O_3) on the central nervous system in mice. METHODS: Specific pathogen free female ICR mice were randomly divided into control group,lowdose group and high-dose group,with 12 rats in each group. The mice in low-dose group and high-dose group were treated with nano-Nd_2O_3 by nasal drip method at 80 and 160 mg/( kg·d) body weight for 30 days,while the mice in the control group were given 0. 9% sodium chloride solution. The water maze experiment and jump platform experiment were used to evaluate learning and memory ability. Hippocampus was examined using Hematoxylin-Eosin( HE) staining and glial fibrillary acidic protein( GFAP) immunohistochemical staining. The level of malondialdehyde( MDA) and the activity of total superoxide dismutase( T-SOD) in brain tissue were detected by microplate reader. RESULTS: The escape latency increased and the step down latency decreased in the low-dose group and high-dose group compared with the control group(P < 0. 05). No obvious pathological changes were observed by HE staining in brain hippocampus. Immunohistochemistry staining showed that the expression of GFAP protein in the hippocampal astrocytes of the low-and high-dose groups was higher than that in the control group,especially in the high-dose group,when compared with the control group. The MDA level increased and the T-SOD activity decreased in the low-and high-dose groups compared with the control group( P <0. 05). CONCLUSION: nano-Nd2 O3 can reduce the learning and memory ability of mice and increased GFAP expression in hippocampal astrocytes. The mechanism may be related to oxidative stress.