Spinal giant cell tumor of bone (GCTB) is a kind of primary benign bone tumors in the spine. It is rich in blood supply,aggressive,and easily recurring and lung metastasizing. So the benign GCTBs of the spine remains a challenge to treat.This article reviews the therapeutic methods in spinal GCTBs,including surgery,radiation therapy,arterial embolization. The treatment for the tumor with lung metastasis is also covered in this review. It is established that En bloc resection with wide margins is the most effective method to spinal GCTBs. To eliminate the residual tumor cells,adjuvant radiation should be done when complete resection is not available. Arterial embolization can be used to treat the huge sacral GCTBs.For those with lung metatasis,they can be controlled by lobectomy and /or chemotherapy.

Objective To investigate the effects of internal plating with high and low moduli of elasticity on the stress and its distribution on the femoral shaft fracture. Methods A femur from a normal Chinese adult male was scanned by 64-detector row helical CT at 0. 5 mm interval. The CT images were used to establish a finite element model of the femur by software. The mid-femoral fracture was simulated in the model and fixated by eight-hole plates of Ti-6Al-4V (high modulus group, E = 110 GPa) and of Ti2448 (low modulus group, E = 30 GPa). When the femur was in axial compression, flexion and torsion loads, the stress and its distribution on the bone fracture site were analyzed to compare the biomechanics of the plates with high and low moduli. Results Under axial compression load, the contact stress between fracture ends in the low modulus group was larger than that in the high modulus group, while the max stress at the hole (11.47MPa) was smaller than that in the high modulus group (13.89 MPa) . Under four-point bending load, the contact stress in the low modulus group was still larger, while the bending movement was smaller. Under the torsion load, stress on the femur was well-distributed in both groups, but the max stress at the hole in the low modulus group (11.47 MPa) was smaller than that in the high modulus group (31.24 MPa). Conclusions Under internal fixation by plates of low modulus, the stress stimulus at the fracture site may be increased,while the stress concentrated at the hole may be decreased. The stress shielding of the low modulus plate may also be modified.

BACKGROUND: Cytokine abnormality, nerve function abnormality and hormone levels may contribute to osteoporosis occurrence following spinal cord injury (SCI), many papers are about cytokine and hormone, but fewer is related to abnormal nerve function on bone accommodation.OBJECTIVE: To innovatively apply blood biochemistry and immunohistochemistry on the observation of change of calcitonin gene-related peptide distributing in trabecular bone of SCI rats, and to analyze its significance in the osteoporosis. DESIGN, TIME AND SETTING: Randomized control animal trials were performed from September 2008 to December 2008 at the laboratory of Orthopedic Institute in the Fourth Military Medical University of Chinese PLA,MATERIALS: Forty-eight Sprague Dawley rats aged 3 months, weighing (210:1:16) g, were divided into SCI group and control group equally. METHODS: Rats in the SCI group underwent spinal cord transection at the tenth thoracic vertebrae. Control rats underwent laminectomy without any spinal cord lesion. MAIN OUTCOME MEASURES: Each 8 rats were sacrificed at 1, 3, 6 weeks postoperatively. The serum concentrations of bone-specific alkaline phosphotase and serum cross-linked N-telopeptide of type Ⅰ collagen were determined. The stain intensity of calcitonin gene-related peptide in trabacular bone was determined with use of quantitative immunohistochemistry technique and computer image analysis system.RESULTS: The cross-linked N-telopeptida of type Ⅰ collagen significantly increased in SCI group at defferent interval compared with control group (P <0.05 or 0.01 ), serum concentrations of bone-specific alkaline phosphotase was lower than control group,without significant difference (P > 0.05). Immunoreactivity of calcitonin gene-related peptide in trabecular bone was strongly positive in control group, while weakened in SCI group (P < 0.05 or 0.01).CONCLUSION: Reduced calcitonin gene-related peptide in trabecular bone of SCI rats may be related to the occurrence of osteoporosis following SCI.

OBJECTIVE: To evaluate the clinical outcomes of medical supporting bone graft following posterior approach and bone cement implantation in the hip joint in treating intertrochanteric fracture.METHODS: A computer-based online search of Science Direct, Ei databases was performed for English articles published between January 1960 and October 2009, with the key words "bone cement, intertrochanteric fracture". In addition, CNKI and CBM were searched for related Chinese articles published between January 1994 and October 2009, with the key words "intertrochanteric fracture, coxa vara, posterior approach of hip joint, bone cement implantation in major screw hole". Moreover,related books were manually searched. Treatment of intertrochanteric fracture, basic and clinical experiment of intertrochanteric fracture treated by bone cement was included.RESULTS: Intertrochanteric fracture treatment includes lateral or anterior approach for dynamic hip plate system, dynamic hip screw, and femoral proximal intramedullary screw internal fixation. Dynamic hip screw is standard internal fixation to treat intertrochanteric fracture, with strong anti-rotation function, and meets the biomechanical requirements. However, screw loosening,extraction and breakage frequently occur. Cancellous bone screw track enhanced by bone cement increases screw retention force,benefits screw compression, enhances bone-screw interface to transfer the stress to screw-bone regions, which significantly increases the anti-flexion and anti-torsion strength of dynamic hip screw and improves fracture stability. The mechanism involves the integral formation of cancellous bone, bone cement and screw by the micro-interlocking of bone trabecula and surrounding cancellous bone.CONCLUSION: Dynamic hip screw filled by bone cement significantly enhances the anti-flexion and anti-torsion strength of internal fixation and improves fracture stability.

Cytoskeletal Proteins ; biosynthesis ; genetics ; physiology ; Humans ; Neoplasm Metastasis ; Neoplasms ; pathology ; Signal Transduction

Objective To investigate the incidence of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD)in neonates with idiopathic neonatal cholestasis (INC)in Nanjing,China,SLC25A13 gene mutations in these neonates,and clinical features.Methods A total of 152 neonates with INC,who were admitted to the Affiliated Nanjing Children's Hospital of Nanjing Medical University from Sep-tember 2009 to August 2013,underwent gene analysis for detecting SLC25A13 gene mutations.The neonates were divided into NICCD group,who had been diagnosed definitely,and INC group at a ratio of 1∶2,considering the age and gender.Several biochemical indices were compared between the two groups.Comparison of continuous data between the two groups was made by Mann-Whitney U test after Bonferroni correction.Results There were 21 confirmed cases of NICCD (21/152,13.82%)among the 152 neonates with INC;five types of SLC25A13 mutations were identified in the 21 neonates with NICCD,including 851_854del (27/42,64.29%),IVS6+5 G→A (7/42, 16.67%),1638ins23 (5/42,11.90%),IVS11 +1 G→A (2/42,4.76%),and Q259X (1/42,2.38%).The alanine aminotransferase (ALT)level,aspartate aminotransferase (AST)level,bile acid concentration,albumin level,fasting blood glucose,blood ammonia,and prothrombin time for the NICCD group were 39.42 ±23.40 U/L,124.85 ±92.65 U/L,142.43 ±24.34μmol/L,30.66 ±2.70 g/L,2.79 ± 0.54 mmol/L,117.57 ±27.88 μmol/L,and 14.03 ±2.79 s,respectively,versus 136.02 ±113.67 U/L,226.12 ±129.26 U/L,80.47 ± 31.53 μmol/L,36.87 ±4.96 g/L,3.14 ±0.45 mmol/L,76.43 ±20.80 μmol/L,and 11.40 ±1.55 s for the INC group.The NICCD group had significantly lower ALT and AST levels than the INC group (Z=-5.02,P=0.000;Z=-3.66,P=0.000);the NICCD group had a significantly higher bile acid concentration than the INC group (Z=-5.58,P=0.000);the NICCD group had significantly lower albumin level and fasting blood glucose than the INC group (Z=-4.52,P=0.000;Z=-2.56,P=0.010);the NICCD group had a significantly higher blood ammonia level than the INC group (Z=-4.75,P=0.000);the NICCD group had a significantly longer prothrombin time than the INC group (Z=-4.10,P=0.000).Conclusion Citrin deficiency due to SLC25A13 gene mutations is an im-portant cause of INC in Nanjing.The three most common mutations are 851_854del,IVS6+5 G>A,and 1638_1660dup23,which account for 92.86% of the SLC25A13 gene mutations.More attention should be paid to clinical analysis and detection of SLC25A13 gene mutations to confirm the diagnosis of NICCD.

Objective To carry out the detection of JAGI gene in children with chronic cholestasis and to im-prove the diagnostic level and understanding of Alagille syndrome. Methods Two cases of chronic cholestasis with multiple organ involvement were selected as the research subjects and their clinical data,laboratory test results were col-lected. Two milliliter peripheral intravenous heparin anticoagulan blood was drawn from each patient. All fragments of 26 exons of the JAGI gene were amplified by polymerase chain reaction - sequence based on typing method. Results One patient with chronic cholestasis,heart murmur and dysmorphic face showed bile duct paucity in liver biopsy and a novel heterozygous mutation c. 809 809delG(p. G270Dfs*142)in 6 exon. Abnormal amino acid replaced JAG1 protein and resulted in truncation of the JAG1 protein. The part of epidermal growth factor(EGF)like repeats region loss and the cysteine rich region completely lost. One case with typical chronic cholestasis and dysmorphic face showed a known IVS20 - 2 5delTAAG heterozygous mutation which resulted in splice site changes. Conclusion A novel JAGI gene mutation c. 809 809delG(p. G270Dfs*142)is helpful to screen JAGI gene of Notch signal transduction pathway for chronic cholestasis with multiple organs involvement in children.

Objective The aim of the study was to investigate the diabetic neuro-degeneration and its changes in neuroreaction to myocardial ischemia and reperfusion,by evaluation of the altera-tion of noxious thermal threshold and expression of substance P (SP),calcitonin gene related peptide (CGRP)in dorsal root ganglia in upper thoracic segments (T1-5 )in diabetic rats.Methods Thirty two male Sprague-Dawley rats,weighing 180-200g,were randomly divided into control group (group C)and diabetic group (group DM),1 6 rats in each group.rats in DM group were fed with high sug-ar-fat diet for 14 weeks and were given streptozotocin (STZ,35 mg/mg,i.p.)at the end of the 4 th week,to set up diabetes experimental model.The animals in control group were fed with standard la-boratory diet.Tail flick latency to thermal stimulation was measured weekly.At the end of 10 weeks after administration of STZ,diabetic rats (and rats in control group)were further divided into myo-cardial ischemia-reperfusion group (group IR)and sham operation group (group Sham).The left an-terior descending branch of coronary artery was occluded for 30 min followed by reperfusion for 120 min,establishing myocardial ischemia-reperfusion.The histological immunofluorescence assay and Enzyme-linked immunosorbent assay (ELISA)were carried out to evaluate the changes of the expres-sions of CGRP and SP in the dorsal root ganglia.Results The tail flick latency was significantly in-creased in group DM,compared to the group C (P < 0.01).The immunoreactive materials for CGRP and SP in the sensory neurons in dorsal root ganglia of upper thoracic segments (T1-5 )were markedly declined in group DM (P <0.01 or P < 0.05).Furthermore,levels of SP and CGRP were signifi-cantly lower in the DRG of the group IR after myocardial ischemia-reperfusion,compared to that in the group sham (P <0.01).Conclusion Diabetes causes sensory denervation and obvious reduction of expression of SP and CGRP in the sensory neuron innervating heart during myocardial ischemia-reper-fusion,indicating impairment of adaptive reactivity of neuro-endocrine function of cardiac sensory nerves.

Objective To evaluate the effects of various resection and reconstruction method on pain relief and function restoration for periacetabular metastatic destruction in different grade. Methods This study involved 20 patients, 11 males and 9 females, with the average age of 52 years(range, 43-82 years). The original tumor consisted of 5 renal cell carcinoma, 4 breast carcinoma, 3 lung carcinoma, 2 thyroid carcinoma, 1 prostate carcinoma, 1 rectum carcinoma and 4 unknown primary cancers. A solitary periacetabular metastatic lesion was demonstrated in 14 patients and multi-metastases were seen in 6 patients, and accompanying periacetabular pathologic fractures in 4 patients. As to the Harrington grading system for the periacetabular metastatic destruction, there were 8 grade Ⅰ, 5 grade Ⅱ, and 7 grade Ⅲ. And according to grade Ⅰ, curettage and cement packing (5 cases) as well as stability reconstruction in iliac and acetabulum (3 cases) were performed; grade Ⅱ, curettage, cement packing and total hip arthroplasty with reinforcement ring was performed; grade Ⅲ, en bolc resection of acetabular lesion and modular prosthesis reconstruction was performed. The average score was 5.4(ranged from 3 to 9) according to Tomita scoring system. The pain relief and functional recovery were investigated from the regular follow up postoperatively. Results All patients showed the improvement in pain relief and mobility postoperatively. No prosthetic dislocation, deep infection and leg length discrepancy occurred. The prosthesis or internal fixation loosening happened in 5 of 15 patients at different stage. The median survival time of all patients was 16.5 months (range from 4.2 to 63 months). 2 patients survived over 5 years, 3 over 2 years, 6 over 1 year, 6 over 6 months, and 3 less than 6 months. According to the Enneking functional scoring system, the patients were rated as excellent in 10 cases, good in 8, fair 1 and poor 1 at the 3rd month postoperatively, and for the 7 cases with grade Ⅲ, excellent 2, good 2, and poor 2. The functions of 11 patients survived one year after surgery were excellent in 3, good 4, fair 2 and poor 2. Conclusion The favorable resections and reconstructions for periacetabular metastatic destruction could lead to remarked improvement in pain relief, functional recovery and quality of life.

[Objective] To evaluate the clinical efficacy of treatment of humeral shaft fracture with revolving intramedullary nails.[Method]Sixty-two cases with fracture of hume ral shaft were treated by revolving intramedullary nails between January 2000 and February 2006.Their were 38 male cases and 24 female cases.Their average age was 36.9(ranged 20～58).Fifty-fous cases were closed fractures,and eight cases were opened.Sixty-two cases with fracture of humeral shaft according to AO classification,41 cases were type A,15 cases were type B,6 cases were type C.Sixty-two patients with the humeral shaft fracture were treated with limited open reduction and minimally invasive internal fixation with revolving intramedullary nails.Scientific and rational rehabilitative treatment was carried out in each case after the operation.All patients were follow-up between 14 months and 30 months.The average follow-up period was 24 months.[Result]The fracture union occurred in sixty-two patients.The average healing time was 15 weeks.According to Rodriquez-Merchang shoulder functional score system,the excellent result was achieved in 36 patients,good in 20 and fair in 6.The excellent and good rate was 90.3%.All cases got good function recovery.The effects were satisfactory.There were no complications in all cases,such as infection,iatrogenic fracture,shortening,break of nail,fat embolism syndrome and peripheral nerve injury.[Conclusion]Revolving intramedullary nails for treatment of humeral shaft fracture is effective with litter interference with the blood supply of the bone fracture and with stable immobilization.Due to the abutment of the longitudinal bars along the entire length of the medullary canal wall,highly resistant to the rotational strength was achieved.The advances of revolving intramedullary nails are convenient in operative procedure with little invasive of operation,early function exercise,high raito of fracture healing and safety compared with the normal operative therapy.The operation indication and timing should be controlled strictly.The manipulation should be familiar.This kind of treatment is worth to be recommended.