OBJECTIVETo evaluate the clinical effects of short-segment transpedicular fixation and vertebroplasty via paraspinal intermuscular approach in treating thoracolumbar fractures.

METHODSFrom January 2009 to January 2012,18 patients with thoracolumbar fractures without neurological symptoms were treated with short-segment transpedicular fixation and vertebroplasty via paraspinal intermuscular approach. There were 11 males and 7 females, aged from 52 to 76 years old with an average of 62.2 years. The duration from injuries to surgery ranged from 8 h to 7 d with an average of 4.2 d. According to the Denis fracture classification, 12 cases got compression fractures and 6 cases got burst fractures.

LOCATION6 vertebra with T12, 9 with L1, 6 with L2, and 3 with L3. Anterior vertebral body height, the sagittal Cobb angle, the sagittal index (SI), condition of internal fixation failure and recurrent kyphosis were observed.

RESULTSAll patients were followed up for 12-28 months with an average of 16.5 months. Operation time was from 80 to 130 min with a mean of 95 min and bleeding volume during operation ranged from 100 to 180 ml with a mean of 145 ml. Anterior vertebral body height ratios preoperation, 3 days after operation and final follow-up was 54.3 +/- 2.8, 90.9 +/- 1.5, 88.6 +/- 1.7, respectively; sagittal Cobb angle was (27.8 +/- 2.5) degrees, (5.3 +/- 0.8) degrees, (6.3 +/- 1.4) degrees, respectively; sagittal index was 52.3 +/- 3.8, 89.2 +/- 5.2, 86.4 +/- 4.5, respectively. Data obtained 3 days after operation obviously improved than preoperation, and there was no statistically significant difference between 3 days after operation and last follow-up. No internal fixation failure, neurological complications and recurrent kyphosis were found.

CONCLUSIONTreatment of thoracolumbar fractures with short-segment transpediclar screw fixation and vertebroplasty via paraspinal intermuscular approach can retain the posterior ligament complex and restore the mechanical strength of the anterocentral column,which proved an ideal method for preventing the failure of internal fixation and reduction of post-traumatic segmental kyphosis.

Aged ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Vertebroplasty ; methods

OBJECTIVETo evaluate the feasibility and efficacy of unilateral pedicle screw fixation in treating thoracolumbar fractures through paraspinal approach.

METHODSFrom January 2006 to January 2009,21 patients with single level thoracolumbar fracture without neurological symptoms were treated with unilateral pedicle screw fixation through paraspinal approach. There were 14 males and 7 females,aged from 21 to 65 years old with a mean of 36.4 years. The duration from injury to operation ranged from 6 h to 5 d with an average of 3 d. According to the classification of Denis fracture, compression fractures happedned in 12 cases and burst fractures happened in 9 cases,including 1 case with T5 fracture, 2 cases with T7 fracture, 2 cases with T10 fracture, 3 cases with T11 fracture, 8 cases with T12 fracture, and 5 cases with L1 fracture. Based on the Flankel grade, all patients were classified as grade E. Anterior vertebral body height ratio, sagittal Cobb angle, condition of internal fixation failure, visual analogue score (VAS) were evaluated.

RESULTSAll patients were followed up from 12 to 36 months with an average of 20.5 months. No internal fixation failure was found. Anterior vertebral body height ratios at preoperative 3 days after operation and last follow-up were 54.3 +/- 2.8, 92.9 +/- 1.5, 93.8 +/- 1.7, respectively;sagittal Cobb angle at the three timepoints were (27.8 +/- 2.5) degrees, (5.3 +/- 0.8) degrees, (6.3 +/- 1.4) degrees, respectively; the difference was statistical significant (P < 0.05). VAS was (1.2 +/- 0.4) points at last follow-up and had obviously improved (P < 0.05).

CONCLUSIONTreatment of thoracolumbar fractures with unilateral pedicle screw fixation through paraspinal approach is safe with the advantages of micro-trauma and less blood loss,which can not only completely retain the posterior spinal complex structure, reinforce the spinal stability, raise the reductional quality, but also improve the strength of fixation and the distribution of stress force.

Adult ; Bone Screws ; Feasibility Studies ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; injuries ; surgery ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo investigate the effects of lentivirus-mediated RNA interference (RNAi) targeting a proliferation-inducing ligand (APRIL) on the chemosensitivity to 5-FU of colorectal cancer cell line LoVo.

METHODSThe lentiviral vector siRNA-APRIL was constructed and verified by PCR and DNA sequencing. LoVo cells were transfected with siRNA-APRIL plasmid, non-targeting siRNA plasmid, or empty plasmid. Forty-eight hours after the transfection, the cells were examined for APRIL expression using Western blot. Seventy-two hours after treatment with 10 µg/ml 5-FU, flow cytometry was used to detect the cell apoptosis and cell cycle changes. The cell growth inhibition rate following 5-FU exposure was detected by MTT assay.

RESULTSPCR analysis and DNA sequencing demonstrated that the RNAi sequence targeting APRIL gene was successfully inserted into the lentiviral vector. siRNA-APRIL transfection resulted in obviously reduced expression of APRIL in LoVo cells. After 5-FU exposure, the apoptosis rate of siRNA-APRIL-transfected cells were increased to (21.12∓3.35)%, significantly higher than that in cells transfected with the non-targeting plasmid or the empty plasmid [(13.06∓1.92)% and (12.28∓1.79)%, respectively, P<0.01]; the cell number in G0/G1 phase increased while that in G2/M phase decreased in siRNA-APRIL-transfected cells. The growth inhibition rate in siRNA-APRIL group was (59.67∓5.03)%, significantly higher than that in the other two groups [(42.33∓4.16)% and (39.67∓4.73)%, respectively, P<0.01].

CONCLUSIONLentivirus-mediated RNAi targeting APRIL can effectively suppress the expression of APRIL in LoVo cells and enhance the chemosensitivity of the cells to 5-FU.

Apoptosis ; drug effects ; Cell Cycle ; drug effects ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Colorectal Neoplasms ; drug therapy ; metabolism ; pathology ; Drug Resistance, Neoplasm ; Fluorouracil ; pharmacology ; Humans ; Lentivirus ; genetics ; RNA Interference ; Tumor Necrosis Factor Ligand Superfamily Member 13 ; genetics ; metabolism

OBJECTIVETo compare the potential incidence of nerve root (ventral and dorsal ramus) injury caused by cervical transarticular screws and Roy-Camille lateral mass screws.

METHODSInsertion techniques with Klekamp transarticular screws and Roy-Camille lateral mass screws were respectively performed in this study. Each technique involved four specimens and 40 screws, which were inserted from C(3) to C(7). And 20-mm-long screws were used to overpenetrate the ventral cortex. The anterolateral aspect of the cervical spine was carefully dissected to allow observation of the screw-ramus relationship.

RESULTSThe overall percentage of nerve invasion was significantly lower with Klekamp (45%) technique than with Roy-Camille (85%) technique (P less than 0.05). The largest percentage of nerve invasion for Klekamp transarticular screws was found at the dorsal ramus (25%), followed by the ventral ramus (15%) and the bifurcation of the ventral dorsal ramus (5%). The largest percentage of nerve invasion for Roy-Camille lateral mass screws was found at the ventral ramus (80%).

CONCLUSIONThe potential risk of nerve root invasion is lower with Klekamp transarticular screws than with Roy-Camille lateral mass screws.

Adult ; Bone Screws ; Cervical Vertebrae ; injuries ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery

OBJECTIVETo investigate the clinical outcomes of lower cervical spinous process laminar screw technique in open door laminoplasty.

METHODSFrom February 2005 to June 2010,12 patients with cervical myelopathy were treated with open door laminoplasty by lower cervical spinous process laminar screw technique. There was intervertebral disc herniation with degenerative stenosis in 5 patients, ossification of posterior longitudinal ligament with osteophyte in 6 patients, cervical traumatic instability with spinal cord injuries in 1 patient. Nerve function, complications, and the cervical canal to body ratio (CBR), range of motion (ROM) and the anteroposterior serial alignment were observed by Japanese Orthopedic Association (JOA) score, X-ray, CT and MRI.

RESULTSThe surgical time was from 1.5 to 2 h with an average of 110 min; blood loss during operation was from 450 to 800 ml with an average of 580 ml. Postoperative complication occurred in 1 case with upper limb pain and 1 case with cerebrospinal fluid leakage. All patients were followed up from 1 to 2 years with an average of 21.8 months. JOA score improved from preoperative 9.5 +/- 1.8 to postoperative 13.6 +/- 2.4 (P < 0.01). X-ray, CT, MRI showed CBR increased obviously (P < 0.01); ROM on flexion-extension and cervical lordosis decreased respectively from (40.0 +/- 10.0) degrees and (65.0 +/- 12.0)% before operation to (15.0 +/- 5.0) degrees and (42.0 +/- 8.0) % at the final follow-up (P < 0.01).

CONCLUSIONLower cervical spinous process laminar screw technique in open door laminoplasty for cervical syndrome is safe and can obtain satisfactory effects, has strong internal fixation and reduce the risk of re-closure.

Adult ; Aged ; Bone Screws ; Cervical Vertebrae ; surgery ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Spinal Stenosis ; surgery

OBJECTIVETo investigate the value of Diffusion-Weighted Imaging (DWI) in the diagnosis of early stage liver diffuse lesions.

METHODSDiethylnitrosamine (DEN) was used to induce liver lesions in rats. Sequential DWI studies were performed on the livers from 1 to 14 weeks after DEN was administered through drinking water. Comparing studies with a blank control group was set and pathohistological examinations of the livers were performed.

RESULTSNo obvious routine MRI morphological change was found in either group during this period, but DWI demonstrated heterogeneous changes in the test group at the cirrhosis stage. There was no significant alteration of the apparent diffusion coefficient (ADC) value in the control group during this period (P > 0.05). The ADC values of the test group began to decline from the fifth week. Until the tenth week, the ADC value of the test group decreased drastically and when b = 300 s/mm2 statistic, the results showed an obvious difference between the two groups. There were also differences between the ADC values at the 10th, the 9th and the 1st weeks of the test group (P < 0.05). When b = 600 s/mm2 and 1000 s/mm2, significant differences were found after the sixth week between the two groups (P < 0.01). The main pathohistological liver change in the test group during the 1 to 4 week period after DEN was administered was swelling of hepatocytes; during the 5 to 8 week period it was fibrous tissues hyperplasia, and in the 9 to 14 week period it was cirrhotic nodule formation.

CONCLUSIONMR functional DWI could detect liver diffuse lesions earlier than conventional MR imaging. Measurement of ADC value may be of use in early diagnosis of liver diffuse diseases and for monitoring the changes of the lesions.

Animals ; Chemical and Drug Induced Liver Injury ; Diethylnitrosamine ; Diffusion Magnetic Resonance Imaging ; methods ; Liver Diseases ; diagnosis ; pathology ; Male ; Rats ; Rats, Wistar

Objective: To explore the effect and security of minimally invasive surfactant therapy (MIST) in treatment of preterm infants with neonatal respiratory distress syndrome (NRDS). Methods: A total of 48 pretrm infants with gestational ages between 30-36 weeks diagnosed with NRDS in Guangzhou Women and Children′s Medical Center from January 2017 to January 2018 were randomly divided into MIST group (23 cases) and intubation-surfactant-extubation+ continuous positive airway pressure ventilation (INSURE) group (25 cases) by adopting random number table method.The patients in MIST group were put on nasal continuous positive airway pressure (nCPAP) and a thin vascular catheter was inserted through the vocal cords under direct vision with direct laryngoscope then infused pulmonary surfactant(PS) into the lung; the patients in INSURE group were endotracheally intubated and infused with PS into the lung through endotracheal tube with positive airway pressure, then extubated and put on nCPAP again.The incidences of adverse reactions and various complications related to the 2 groups were observed. Results: There were no significant differences between 2 groups in oxygen saturation decrease(26.1% vs.36.0%), bradycardia (13.0% vs.24.0%) and reuse PS (8.7% vs.4.0%) (all P>0.05). There were no significant differences between 2 groups in noninvasive ventilation time [8 d (5.5-12.5 d) vs.7 d(5.0-14.0 d)], total oxygen intake time [12 d(7.0-26.5 d) vs.10 d(10.0-23.0 d)] and length of hospital stay [(34.22±16.06) d vs.(30.88±14.35) d] (all P>0.05). There was no death or intraventricular hemorrhage in both groups, and there were no significant differences between 2 groups in the incidences of pneumothorax (0 vs.4.0%), bronchopulmonary dysplasia (21.7% vs.16.0%), retinopathy of prematurity (21.7% vs.12.0%) and necrotizing enterocolitis (21.7% vs.12.0%) (all P>0.05). Conclusions MIST technique is a safe and effective method to administrate surfactant in preterm infants with NRDS.In the NRDS patients who do not need intubation and mechanical ventilation, MIST technique can be used to administrate PS.

Objective To investigate the effects of acupoint injection of mouse nerve growth factor (mNGF) on treatment of children with autistic spectrum disorders in different age groups. Methods Totally 80 cases of children with autistic spectrum disorders were divided into control group and experiment group according to random number table method, with 40 cases in each group. The control group was given structured education, ABA behavioral training, sensory integration training, and language training, 30 min for each class, 4 h each day, 5 d a week, for 5 months. At the same time, the control group was also given head needling treatment, once every other day, 3 times a week, 30 times as one treatment course, 2 courses. On the basis of the treatment of the control group, experiment group was given mNGF through acupoint injection, once every other day, 3 times a week, 10 times as one treatment course, 10 d between each treatment course, 5 courses in total. The scores of autism behavior checklist (ABC), children autism and related developmental disorders psychological education rating scale-Chinese version (C-PEP), neuropsychological development scale among children aged 0–6 years in the two groups were compared. Results Compared with before treatment, ABC scores in both group after treatment decreased significantly (P<0.05); ABC scores after treatment in children aged 18–36 months and 37–54 months in the experiment group were lower than those of the control group (P<0.05). Neuropsychological development scale scores in children aged 18–36 months and 37–54 months were better than the control group (P<0.05). Compared with before treatment, C-PEP scores of both groups increased significantly (P<0.05). There was statistical difference in the C-PEP scores in children aged 18–36 months between the two groups after treatment (P<0.05). The C-PEP scores in children aged 18–36 months increased to the highest (P<0.05).Conclusion Acupoint injection of mNGF can improve the clinical symptoms and intelligence of ASD children of all ages, but children can receive better treatment effects at younger ages.

Intercellular adhesion molecule-1 (ICAM-1) is an important adhesion molecule leading to adhesion between cells; NF-kappaB, being universally distributed in the organism, is an important nuclear transcription factor leading to a rapid response to the stimuli. Line of evidence have shown that ICAM-1 transcription and NF-kappaB activation is an important step of inflammatory reaction. To testify that intrapulmonary regulatory peptides modulate inflammatory lesion of bronchial epithelial cells (BECs) through their effect on ICAM-1 expression and nuclear factor kappaB (NF-kappaB) activation, we used immunocytochemistry, RT-PCR, and electrophoretic mobility-shift assay (EMSA) to determine the ICAM-1 expression and NF-kappaB activity in BECs. The effects of NF-kappaB inhibitor MG-132 on ICAM-1 expression were also observed. The results showed that vasoactive intestinal peptide (VIP) and epidermal growth factor (EGF) decreased ICAM-1 expression in O(3)-stressed BECs, while endothelin-1 (ET-1) and calcitonin gene-related peptides (CGRP) increased ICAM-1 expression in resting BECs. MG-132 blocked ICAM-1 expression induced by O(3), ET-1 and CGRP. The results obtained by using EMSA confirmed that VIP and EGF restrained the activation of NF-kappaB in O(3)-stressed BECs; CGRP and ET-1 promoted activation of NF-kappaB. These observations indicate that VIP and EGF abated the injury by means of down-regulatory effects on ICAM-1 transcription and NF-kappaB activation, while ET-1 and CGRP enhanced the inflammation reaction by an up-regulatory effect. It is suggested that a developing and intensive airway inflammation correlates closely with a persistent expression of ICAM-1 and repeated activation of NF-kappaB.
Animals ; Bronchi ; cytology ; Cell Adhesion ; physiology ; Cells, Cultured ; Endothelin-1 ; metabolism ; Epithelial Cells ; cytology ; metabolism ; Humans ; Inflammation ; metabolism ; Intercellular Adhesion Molecule-1 ; metabolism ; NF-kappa B ; metabolism ; Peptides ; physiology ; Rabbits ; Vasoactive Intestinal Peptide ; physiology

BACKGROUNDTransfacet pedicle screws provide another alternative for standard pedicle screw placement for plate fixation in the lumbar spine. However, few studies looking at transfacet pedicle screw fixation in the cervical spine are available. Therefore, cervical transfacet pedicle screw fixation and standard pedicle screw fixation techniques were biomechanically compared in this study.

METHODSTen fresh human cadaveric cervical spines were harvested. On one side, transfacet pedicle screws were placed at the C3-4, C5-6, and C7-T1 levels. On the other side, pedicle screws were placed at the C3, C5, and C7 levels. The screw insertion technique at each level was randomized for right or left. The starting point for the transfacet pedicle screw insertion was located at the midpoint of the inferolateral quadrant of the lateral mass and the direction of the screw was about 50 degrees caudally in the sagittal plane and about 45 degrees toward the midline in the axial plane. Screws were placed from the inferior articular process, across the facet complex and the pedicle into the body of the caudal vertebra. The entry point for the pedicle screw was located at the midpoint of the superolateral quadrant of the lateral mass, and the direction of the screw was about 45 degrees toward the midline in the axial plane and toward the upper third of the vertebral body in the sagittal plane. After screw placement we performed axial pullout testing.

RESULTSAll the cervical transfacet pedicle screws and the pedicle screws were inserted successfully. The mean pullout strength for the transfacet pedicle screws was 694 N, while for the pedicle screws 670 N (P=0.013). In all but six instances (10%), the pedicle screw pullout values exceeded the values for the transfacet pedicle screws; this occurred three times at the C3/C4 level, twice at the C5/C6 level and once at the C7/T1 level. The greatest pullout strength difference at a single level was observed at the C5/C6 level, with a mean difference of 38 N (t=-1.557, P=0.154). The C7/T1 level had a mean difference of 26 N and the C3/C4 level had a mean difference of 14 N.

CONCLUSIONSCervical transfacet pedicle screws exhibited higher pullout strength than pedicle screws. Posterior transfacet pedicle screw fixation in the cervical spine may afford an alternative to standard screw placement for plate fixation and cervical stabilization.

Biomechanical Phenomena ; Bone Screws ; Cervical Vertebrae ; physiology ; surgery ; Humans