[Objective]To investigate the methods of surgical treatment of complicated lumbar spinal stenosis. [Methods]Totally 176 patients who were diagnosed as having complicated lumbar spinal stenosis,operated by back decompression,fused by bone graft and internal fixed by pedicle screws from January 1997 to January 2001 were retrospectively analyzed.Ninety-eight were males and 78 were females,with an average age of 58.5 years.Patient history was from 2 to 31 years.Thirty-five patients had a previous surgery on lumbar vertebrae,and 19 patients had two or more.Forty patients were complicated with one degree degenerated olisthe,42 were complicated with lumbar scoliosis and Cobb's angle more than 20?,21 had lumbar unsteadiness after surgery,19 patients had spinal stenosis in juncture after surgery.One ore two segments intervertebral discs were removed and vertebral plate were closed together,fused by bone graft and fused articular process.To the patients with more than two segments affection,processus articularis and processus transverses were fused to the patients need not remove intervertebral disk or remove less than half of processus articularis and interbody vertebral were fused to the patient need remove intervertebral disk.Patients with scoliolosis were decompressed and inserted pedicle screws.Revolve rod combined with compression and brace technique was used to correct scoliolosis,fuse the disk and articular process to the patient with severe intervertebral disk hernia and others were fused post-lateraly.[Results]Operation time was from 80 to 250 minutes.Blood loss was from 450ml to 1600ml and no patient died.The follow-up duration averaged 5.6 years.Fused disks had good to excellent rate of 87.4%,and multi-segments had good to excellent rate of 86.1%,and combined with scoliolosis good to excellent rate of 89.8%.The Cobb's angle was average 6.7? and correct rate was 73.8%.The fused rate of post-lateral was 92%(60/65),while the interbody vertebral fused rate was 97.9%(139/142).[Conclusion]The operation of complicated lumbar spinal stenosis is difficult to operate and has high risk.Back decompression,fused by bone graft and internal fixation by pedicle screws is a good method.

Objective:To construct the lentiviral-vector encoding human interleukin-10 protein(LV-hIL-10) and to observe the effect of LV-hIL-10 on controlling neuropathic pain via intrathecal administration in CCI rats. Methods:hIL-10 gene fragment was isolated and amplified from pCYIL-10 plasmid by PCR, and was cloned into pWPXL. The recombinant plasmid pWPXL-IL-10,envelope plasmid pMD2.G and packaging plasmid psPAX2 were cotransfected into 293T cells, LV-hIL-10 is prepared by concentrating the collected supernatant .At the same time, the empty plasmid pWPXL-GFP,pMD2.G and psPAX2 were cotransfected into 293T cells, LV-GFP is prepared for contrast.135 sheer breed pathogen-free adult male Sprague-Dawley rats divided into 9 arrays at random: CCI models 4 arrays (C0,C1,C2,C3), sham operatived rats 4 arrays (S0,S1,S2,S3) and a normal contrast array (N), each respectively intrathecal injection LV-hIL-10 (C1,S1)、LV-GFP (C2, S2),isotonic Nachloride (C3,S3) and control (no implanted catheters and no administration, C0,S0), the pain threshold of each array and the expression of mRNA and protein of IL-10 in spinal cord,pallium and hippocampus on different time were observed after intrathecal administration LV-hIL-10 in successful CCI model rats . Results:The hIL-10 gene fragment was obtained from pCYIL-10 plasmid, pWPXL-hIL-10 was recombinated successfully. the cloned gene segment was validated by DNA sequencing .High titer(2?1010)and highly purified LV-hIL-10 particles were obtained by three plasmids were cotransfected into 293T cells. The mechanical allodynia and thermal hyperalgesia were alleviated via intrathecal injection LV-hIL-10 in CCI rats. The overexpression of IL-10 were detected in spinal cord,pallium and hippocampus , especially in the spinal cord .Conclusions:The mechanical allodynia and thermal hyperalgesia can be relieved by intrathecal injection LV-hIL-10 in CCI rats.

Objective To investigate the relationship of Toll-like receptors (TLRs) 2 and 4 with the occurrence of chloasma.Methods Peripheral blood samples were collected from 40 patients with chloasma and 40 healthy human controls,and skin samples were also collected from the lesions of 10 of the patients and normal skin of 10 of the healthy controls.Real time (RT)-PCR was performed to measure the mRNA expressions of TLR2 and TLR4 in skin lesions and blood samples.An immunohistochemical test was conducted to observe the expressions of TLR2 and TLR4 in skin lesions.Statistical analysis was carried out by t test.Results The expressions of TLR2 and TLR4 mRNAs were both significantly higher in skin lesions of the patients than in normal skin of the controls (9.72 ± 2.93 vs.5.10 ± 2.69,t =3.67,P＜ 0.01; 9.52 ± 2.88 vs.4.77 ± 1.90,t =4.36,P＜ 0.01),while no significant difference was found in the mRNA expressions of TLR2 or TLR4 in peripheral blood between the patients and controls (both P ＞ 0.05).As the immunohistochemical test revealed,TLR2 was absent in both the epidermis and vascular endothelial cells in 6 normal control skin samples,weakly expressed in the basal layer of the epidermis but absent in vascular endothelial cells in 4 normal skin samples,and no TLR4 expression was observed in either the epidermis or vascular endothelial cells in these control skin samples.Among the 10 skin samples from chloasma lesions,3 showed TLR2 expression in the whole epidermis,7 in both basal cell layer and prickle cell layer but not in vascular endothelial cells in the superficial dermal layer,all showed strong TLR4 expression in the basal cell layer and weak TLR4 expression in the prickle cell layer,and 3 exhibited TLR4 expression in vascular endothelial cells in the superficial dermal layer.Conclusion TLR-mediated immune responses in local skin might be related to the occurrence of chloasma.

Objective To evaluate the reliability and reproducibility of the thoracolumbar osteoporotic vertebral compression fracture (OVCF) severity score system (TLOFS),so as to provide basis for clinical decision-making.Methods A total of 320 cases of thoracolumbar OVCF hospitalized between January 2014 and June 2015 were scored by TLOFS.There were 107 male and 213 female patients,aged 52-90 years (mean,63.78 years).All cases presented with a chief complaint of low back pain.Thirty-nine cases (TLOFS ≤3 in 21 cases,TLOFS =4 in 17 cases) were treated non-operatively,while 259 cases (TLOFS =4 in 23 cases,TLOFS ≥ 5 in 259 cases) were treated surgically.Pain was evaluated by the visual analogue scale (VAS).Reliability,reproducibility and content validity of the TLOFS were analyzed.Results Cronbach' sα coefficients of all TLOFS subgroups including evaluation of morphological changes,MRI,bone mineral density,clinical situation and therapy recommendation and total score evaluation were within the range of higher to high reliability (0.76-0.94).Kappa coefficients of all TLOFS subgroups were within the range of higher to high reproducibility (0.84-0.95).Mean content validity of all TLOFS subgroups was 0.916.VAS improved from preoperative(7.8 ± 2.1) to (1.3 ±0.7) at the final follow-up.Rates of correct diagnosis,sensitivity and specificity were 95.7％,87.6％ and 96.5％ respectively.Conclusion TLOFS exhibits good reliability and reproducibility,easy operation,and accurate and comprehensive evaluation,which is effective in guiding the clinical decision making in treatment of thoracolumbar OVCF.

Objective To investigate the effect of ischemia and ischemia/reperfusion(I/R)in rat heart on matrix metalloproteinase-1(MMP-1).Methods The I/R animal models were established by shutting down and reopening the anterior interventricular branch with a silver clamp,then the distribution and amount of MMP-1 of the normal and I/R rat hearts were observed by immunohistochemical staining and Western blotting and analyzed by computer image analysis.Results 1.Immunohistochemical staining showed MMP-1 existed mainly in the cardiac matrix.There were strong positive reactions in fibrocytes,smooth muscle cells of the blood vessel and endotheliaI cells of capillaries.MMP-1 didn't show distinct changes 30 minutes after ischemia,while its concentration increased dramatically 60 minutes after ischemia.The positive reaction of MMP-1 increased 30 minutes after I/R,and 60 minutes after I/R there was large fusion areas in MMP-1 existing reglons.2.Quantitative analysis showed no dramatic changes of MMP-1 after ischemia for 30 minutes(P＞0.05),while dramatic changes were seen 60 minutes after ischemia(P＜0.05).MMP-1 changed dramatically 30 minutes and 60 minutes after I/R.3.Western blotting showed that there were no distinct naked-eye-observable changes.The bands of MMP-1 became widened 30 minutes after I/R,and became obviously widened 60 minutes after I/R.Conclusion 1.MMP-1 is secreted by fibrocytes,smooth muscle cells and endothelial cells of cardiac tissue under physiological conditions,and cardiomyocytes has the potential to secrete MMP-1 under ischemia or I/R.2.The longer time the heart ischemia lasts,the greater MMP-1 concentration will increase.Reperfusion can increase MMP-1 concentration to an even higher level,which may be the main cause of the collagen destruction after heart I/R.

Objective To compare the clinical outcomes of Bryan disc replacement with anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylopathy. Methods Sixteen patients underwent Bryan cervical disc replacement (A group), and 35 patients underwent traditional ACDF (B group) were included in the study. Patients were followed up at regular intervals. The JOA score, SF-36, neck disability index (NDI) score and the dynamic flexion-extension radiographs were used to evaluated the oucomes.Results All the patients were followed up for more than 6 years (mean, 73.5 months). There were no severe adverse events in both groups. In A group, there were no differences between postoperative and preoperative mobility of surgical segments (P＞0.05). All patients obtained bone fusions 6 month after surgery in group B.In both groups, the clinical symptoms relieved obviously after surgery. The postoperative scores of the JOA,SF-36 and NDI significantly improved compared with those of preoperative ones (P＜0.05). In B group, range of motion (ROM) was significantly decreased postoperatively (P ＜0.01); in A group, there were no significant differences between postoperative and preoperative ROM (P＞0.05). The difference between two groups regarding ROM was noted (P＜0.05). Conclusion The mid-term outcomes of Bryan cervical arthroplasty are satisfied. And the cervical arthroplasty which can maintain the mobility of the segment, and decrease the incidence of the postoperative neck axial symptoms is a viable alternative to cervical spondylopathy.

Objective To discuss the selection of surgical treatment for lower cervical fractures and dislocations combined with locked-facet. Methods The clinical data of 68 patients with lower cervical spine fracture and dislocation combined with locked-facet were retrospectively analyzed. There were 33 patients with unilateral facet dislocation and 35 with bilateral facet dislocation. According to American Spinal Injury Association (ASIA) score, there were five patients at grade A, 11 at grade B, nine at grade C and 10 at grade D. All patients underwent skull traction. Anterior decompression and fixation were applied for reduction of the locked facet. Posterior unlocking reduction ,anterior decompression and plat fixation were applied for the patients with no reduction. Results There were no injuries on major blood vessels, trachea, esophagus, spinal cord. The follow-up lasted for average 41.5 months, which showed that the intervertebral height and lordosis were maintained normal. At six months postoperatively, bony fusion was achieved, with no plate and screw-related complications. The patients with neurological defect got improved at different degrees postoperatively. Conclusion For different lower cervical spine fractures and dislocations combined with locked-facet, selection of suitable surgical approach can attain satisfactory outcome.

Wide- angle viewing system as an important auxiliary device can clearly observe the whole fundus field of vision in vitreous surgery, which enable vitreoretinal surgery more efficient, safer and more effective. So it has very high application value in ophthalmologic operation. In this paper, we studied the development and application of wide - angle viewing system in vitreoretinal surgery in recent years, from which we summed up the advantage of non - contact wide - angle viewing system in clinical field, and pointed out the shortcomings. The ultimate goal is to make the non -contact wide - angle viewing system better applied in vitreous surgery.

Objective:To investigate the role of MicroRNA-9-1 in inducing epidermal stem cells(ESCs) differentiation into neurons.Methods:The lentiviral of MicroRNA-9-1 was constructed and transfected into rats epidermal stem cells.The experiment was divided into transfected group,non-transfected group and the negative control group.The β-mercaptoethanol was as an inducer for triggering the ESCs to differentiate into neurons.The GFP fluorescence expression of epidermal stem cells after transfection was observed under inverted fluorescence microscope.The protein and mRNA expression level of microtuble-associated protein 2 (MAP-2) was detected by immunocytochemical method and RT-PCR,respectively.Results:The result of Positive clone PCR confirmed successful construction of MicroRNA-9-1 in rats.Transfection after 48 h,the expressing of GFP fluorescence at peak in transfected group,and transfection efficiency reached (85.6+1.9)％.Most ESCs differentiated into neurons in transfected group after β-mercaptoethanol induction 7 h,and the effect was significantly better than non-transfected group and the negative control group.The protein ((87.3± 0.6)％) and mRNA (about twice over) expression levels of MAP-2 in transfected group was higher than those in non-transfected group and the negative control group (P＜0.05).Conclusion:The lentiviral of MicroRNA-9-1 has high transfection efficiency in rats ESCs,and could promoted ESCs differentiate into neurons under β-mercaptoethanol induced.

Objective To compare the efficacy of KumaFix posterior spinal screw/rod system (KumaFix system) and posterior U-shape screw/rod system for treatment of thoracolumbar vertebral body fractures.Methods A total of 131 patients with thoracolumbar vertebral body fractures treated from January 2011 to July 2011 were prospectively analyzed.All patients showed thoracolumbar injury classification and severity score (TLICS) more than 5 points and spinal load-sharing classification (LSC) score of 4-6.The patients were assigned to two groups according to the coin toss method:group A (n =72,treated with reduction and fixation with KumaFix system in combination with transpedicular bone grafting of fractured vertebrae) and group B (n =59,submitted to posterior reduction and fixation with U-shaped screw/rod system in combination with transpedicular bone grafting of fractured vertebrae).In group A,there were 41 male and 31 female patients at age of (41.2 ± 4.9) years (range,20-53 years).In group B,there were 33 male and 26 female patients at age of(40.6 ± 4.5)years (range,21-51 years).The two groups were analyzed and compared in aspects of operation time,blood loss,anterior vertebral height ratio,middle vertebral height ratio,posterior vertebral height ratio,kyphosis angle,Oswestry disability index (ODI) and incidence of adjacent segment degeneration.Results All patients were followed up for mean 5.3 years (range,5.1-5.8 years).Operation time and blood loss were (72.5 ±21.8)rain and (320.6 ±90.0)ml in group A,less than (104.3 ±20.7)min and (421.0 ± 84.5) ml in group B (P ＜ 0.05).Both groups achieved obvious improvements in anterior vertebral height ratio,middle vertebral height ratio,posterior vertebral height ratio and kyphosis angle after operation(P ＜ 0.05).At the last follow-up,the middle vertebral height ratio was (92.0 ± 2.8) ％ in group A,better than (84.1 ± 5.1) ％ in group B (P ＜ 0.05).Both groups showed improvement in ODI after operation (P ＜ 0.05).At the last follow-up,ODI and incidence of adjacent segment degeneration were 11.9 ± 7.1 and 0 in group A,decreased compared to 20.9 ± 6.7 and 12％ in group B (P ＜ 0.05).Conclusions For thoracolumbar vertebral body fractures,the KumaFix system has better reduction effect than U-shape screw/rod system.Meanwhile,the KumaFix system can avoid negative effect.