[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.

Adipates ; analysis ; Air Pollutants, Occupational ; analysis ; Esters ; analysis ; Gas Chromatography-Mass Spectrometry ; methods ; Phthalic Acids ; analysis ; Workplace

BACKGROUND:Ultrasound therapy can relieve pain and improve the movement function in patients with knee osteoarthritis, but there lacks of consistency in the literatures of ultrasound therapy.
OBJECTIVE:To further identify the effectiveness of ultrasound therapy in the treatment of knee osteoarthritis.
METHODS:Twenty-four rabbits were randomly divided into three groups:normal group, model group and ultrasound group. The rabbit in the normal group received no intervention;rabbits in the model group received anterior cruciate ligament transaction to establish the knee osteoarthritis model without any treatment;the rabbit in the ultrasound group received ultrasound therapy after modeling for 10 minutes once time, once per day, 0.3 W/cm2 , 1 MHz and treated for 10 times. Hematoxylin-eosin staining was conducted for histological observation of rabbit articular cartilage;western blot and reverse transcription PCR assessment were used to assess the expressions of caspases-3 and caspases-8 in rabbit articular cartilage, while Terminal deoxynucleotidyl transferase dUTP nick end labeling was used to assess the ratio of chondrocytes apoptosis of rabbit knee articular cartilage.
RESULTS AND CONCLUSION:The normal rabbit cartilage tissues and chondrocytes were neatly arranged in column;the middle cartilage layer of the model was thin;the chondrocytes were arranged disorderly and became less. After ultrasound therapy, the chondrocytes were rearranged neatly, and the number was increased. Compared with the normal group, the Mankin scores in the model group and ultrasound group were higher;the apoptotic rate of chondrocytes was higher in the model group and ultrasound group than in the normal group, and was also higher in the model group than in the ultrasound group. Compared with the normal group, the expressions of caspases-3 and caspases-8 were higher in the model group and the ultrasound group, while decreased after ultrasound therapy. The results indicate that ultrasound can improve the structure of cartilage tissues, decrease the expressions of caspases-3 and caspases-8 and reduce the apoptosis rate of chondrocytes. It is effective for the treatment of knee osteoarthritis with ultrasound therapy.

To screen the optimal formula and evaluate the quality of testosterone undecanoate ( TU) binary ethosomes to lay the foundation for the transdermal delivery system of TU. Methods:The mixture of ethanol and propylene glycol was used as the softeners, and TU binary ethosomes were prepared by ethanol injection method. The ratio of TU to lipids ( A) , the quality percentage of the mixture of ethanol and propylene glycol ( B) and the ratio of ethanol to propylene glycol ( C) as the influencing factors, and the entrapment efficiency as the index, an orthogonal test was used to optimize the formula of TU binary ethosomes. The morphology, size, zeta potential, in vitro drug release and stability of TU binary ethosomes were studied. Results:The optimal formula of TU binary etho-somes were as follows:the ratio of TU to lipids was 1∶15, the quality percentage of the mixture of ethanol and propylene glycol was 10% and the ratio of propylene glycol to ethanol was 6∶4. The optimal TU binary ethosomes were concentric circles under an optical microscope with uniform size, and the average size was (185. 5 ± 52. 8)nm, zeta potential was ( -15. 87 ± 0. 26)mV, and the entrap-ment efficiency was (79. 14 ± 0. 66)%. TU release from the binary ethosomes in vitro was fitted the first-order equation:Q=20. 79t-11. 01 (r2 =0. 998 4). Under the high temperature, the entrapment efficiency was decreased significantly, while under the other test conditions, all the indices of TU binary ethosomes showed no significant difference. Conclusion:The optimal TU binary ethosomes are easy to be prepared with promising quality and sustained release property in vitro, which are valuable to be studied further.

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 explore the causes and clinical treatments of recurrent spinal tuberculosis complicated with sinus tract.Methods There were 21 patients suffered from recurrent spinal tuberculosis complicated with sinus tract in 87 patients with complicated spinal tuberculosis from January 1997 to January 2012.The dates of them were reviewed.There were 12males and 9 females with an average age of 38.8 years (range,22-58 years).There were 15 patients whose tuberculosis bacterial culture and drug sensitive experiments suggested drug resistance.All patients were excluded from mixed infection of sinus before the operation.According to the range of the tuberculous abscess,11 patients had undergone one stage sinus clearing and debridement,instrument removal,spinal fusion and internal fixation by anterior approach.The other 10 patients had undergone one stage anterior sinus clearing and debridement,instrument removal,bone graft and internal fixation by posterior approach.Results All patients were followed up for an average time of 29.7 months.16 patients were recovered.5 patients got recurrence with the rate of 23.8％(5/21).The recurrence rate of anterior internal fixation was 18.2％(2/11),and 30％ (3/10) for posterior internal fixation.3patients got recovered by conservative treatment and 2 patients by re-debridement.15 patients achieved bone fusion 6 months after the operation; 4 patients achieved bone fusion 9 months after the operation; 1 patient achieved bone fusion 12 months after the operation.The kyphosis Cobb' angle was corrected to 5.7°(ranged from 2° to 12°).Conclusion It is difficult for the treatment of recurrent complicated spinal tuberculosis combined with sinus tract.The causes of recurrence include drug-resistant strains of TB,uncompleted debridement,failure of spinal stability reconstruction,and combination with other organ tubeculosis.The key of successful surgical treatment includes effective chemotherapy,radical debridement and proper reconstruction of spinal stability.

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 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 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.

Objective To analyze the features of normal high-frequency ultrasonography of tarsal tunnel. Methods Forty volunteers (20 males and 20 females) were examined with high-frequency ultrasound (12 MHz). The tendons,nerve and blood vessels in tarsal tunnel were observed from short-axis and long-axis views dynamically. The areas of tarsal tunnel and posterior tibial nerve were measured and com-pared between the males and females. Results High-frequency ultrasonography depicted the anatomical structure of tarsal tunnel,and the tendons,nerve and blood vessels presented different sonographic features that were easy to differentiate. The area of tarsal tunnel: male (7.61 ±1.00) cm2,female (6. 61 ± 1. 07) cm2 (P <0. 01). The area of posterior tibial nerve: male (9. 59 ± 0. 75) mm2,female (8.91 ±0.74) mm2(P<0.01). Conclusion High-frequency ultrasonography can clearly show and accurately measure the tarsal tunnel structure. To be familiar with the normal ultrasonographic anatomy of tarsal tunnel will help to improve the efficacy of ultrasound diagnosis of tarsal tunnel abnormalities.