Objective To explore the changes of bone mineral density (BMD) and bone markers in senile osteoporosis patients treated with teriparatide,and evaluate the improvement on quality of life (QOL) as well as the clinical significance.Methods Forty-five senile osteoporosis inpatients were treated with 20 μg of teriparatide for one year.BMD and bone markers were detected before treatment and also in the third,sixth and twelfth month during treatment.The level of numerical rating scale (NRS) and QOL were assessed.Results The NRS before treatment was (4.96±2.25) , and those after treatment of 3, 6 and 12 months were(2.84±1.41), (1.56±1.16) and (1.36±1.00), respectively (P<0.01).The total scores of SF-36 significantly increased after treatment (P<0.01).After treatment of 3, 6 and 12 months, BMD of lumbar vertebra had increased 7.7%, 12.3% and 15.4%, respectively;that of femoral neck had increased 3.0%, 6.1% and 7.6%, respectively;and that of intertrochanteric bone had increased 5.7%, 8.6% and 10.0%, respectively.Meanwhile, the serum levels of osteocalcin, bone alkaline phosphatase and N terminal propeptide of type I procollagen were significantly higher than those before treatment (P<0.01), nevertheless beta collagen cross-linked C-terminal peptide (β-CTX) only significantly decreased at the 12th month after treatment (P<0.05).Conclusion Chronic teriparatide therapy could significantly relieve bone pain,improve the quality of life and increase lumbar vertebra BMD in senile osteoporosis.

AIM: To explore the effects of hydrogen sulfide (H_2S) on proliferation of vascular smooth muscle cells (VSMC) stimulated by endothelin (ET-1, 10 -7 mol/L ) and mitrogen-activated protein kinase (MAPK) activity in VSMCs. METHODS: Cultured VSMCs were divided into six groups: (1) control group, (2) serum group, (3) endothelin group, (4) NaHS groups, (5) serum+NaHS group, and (6) endothelin+NaHS group. VSMC proliferation was measured by [ 3H]-TdR incorporation and MAPK activity in VSMC was determined by radioactivity assay. RESULTS: ET-1 increased VSMC [ 3H]-TdR incorporation by 2.39 times ( P

Objective To investigate the feasibility of percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. Methods One patient with thoracic disc herniation involved the level of vertebral segment in T11/12 was treated with percutaneous transforaminal endoscopic spine system and followed up for 1 month. The targeted puncture was performed under local anesthesia and fluoroscopic guidance with patient in prone position. The foramen of T 11/12 was enlarged gradually with four trephinations, and the working cannula was inserted transforaminal into the canal. Then the herniation was exposed and removed with full endoscopic technique, including the loosen nucleus pulposus. The dural sac was exposed and released adequately. Drainage was placed during operation. Results The procedure was successfully carried out and the dural sac was completely released. The drainage was removed in the second day of operation. The patient could walk in the third day after operation with obvious relief of back and leg pain. At the follow-up of one month postoperation, the visual analogue scale of leg pain decreased from 8 to 1, and the Oswestry disability index (ODI) decreased from 64 to 4. According to MacNab scale, excellent result was acquired. Conclusion There is the feasibility of the percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. It is a good minimal invasive technique with good results and high technical requirements for surgeons.

AIM: The activity and expression of neutral endopeptidase (NEP) and the adrenomedullin (ADM) contents in various tissues were observed in septic shock and control rats to study the possible role of NEP in the change of ADM contents in tissues during septic shock. METHODS: The septic shock model of rats were established by cecal ligation and puncture (CLP). ADM contents, NEP activities, level of NEP mRNA and NEP protein were measured. RESULTS: (1) In early septic shock (ES), the ADM contents were generally higher in detected tissues, the NEP activity in left ventricle and small intestine were lower and was higher in blood than those in controls, and in lung, kidney and aorta were similar with the controls. NEP immunoreactive staining were less in lung, left ventricle, endothelium and media of aorta, but more in adventitia of aorta and kidney than those of the controls; (2) In late septic shock (LS), the ADM contents in small intestine was less but in plasma and other tissues were higher, and the NEP activity were less in plasma and other tissues than those in ES. The NEP immunoreactive staining were less in heart, endothelium and media of aorta, lung and kidney than those in ES, and was no significant change in adventitia of aorta compared with those of ES. RT-PCR found that NEP gene expression were significantly less in left ventricle, aortas, lung and small intestine than those in the controls. CONCLUSIONS: In septic shock rats, the NEP activity changes heterogeneously but the ADM contents elevate in most tissues. These results indicate that during the septic shock, the local concentrations and actions of ADM in various tissues may be regulated differently by the NEP. [

Objective To evaluate the clinical efficacy of treatment of severe thoracolumbar burst fractures by posterior short-segment instrumentation without spinal fusion and assess radiographic imaging and function recovery after surgery.Methods Thirty-eight patients with severe monosegmental thoracolumbar burst fractures treated between July 2011 and March 2013 were analyzed retrospectively.Operation procedures were posterior short-segment pedicle screw distraction reduction and fixation combined with screw insertion to the injured vertebrae and calcium sulphate augmentation.In addition,there was no need for posterolateral interbody fusion.X-ray and CT were performed before and after operation to evaluate local kyphotic angle,anterior fractured vertebral body height and canal encroachment.Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before and after operation as well as in follow-up.Results All patients were followed up for average 14 months (range,3-20 months).Local kyphotic angle was (21.2 ±4.3)° before operation,(3.5 ± 1.8)°immediately after operation,and (4.8 ± 2.7) ° in final follow-up.Relative anterior vertebral height was (54.8 ± 14.6)％ before operation,(91.7 ± 8.0)％ after operation,and (87.2 ± 6.0)％ in final follow-up.Mean canal encroachment was (48.0 ± 4.5)％ preoperatively,(23.8 ± 7.8)％postoperatively,and (8.8 ± 4.6) ％ in final follow-up.In final follow-up,six patients with American Spinal Injury Association (ASIA) grade C on admission showed improvement to grade D (n =2) and grade E (n =4) ; 10 patients with ASIA grade E on admission showed improvement to grade E; 22 patients with grade E had no changes.ODI and VAS scored 15.5 ±8.8 and 2.3 ±0.8 in final follow-up with substantial improvement from those before operation (P ＜ 0.01).Complications from internal fixation were not found during follow-up.Conclusion Posterior short-segment fixation without fusion is one of the foremost effective methods for severe thoracolumbar burst fractures,for it can effectively restore the sagittal spinal alignment and the fractured vertebral body height.

Objective To estimate curative effect of reconstruction of rabbit knee joint cartilage defect with the homogeneitic tissue engineered cartilages.Methods The chondrocytes were isolated and collected from articular cartilages of eight New Zealand white rabbits.The tissue engineered cartilages after culturing chondrocytes and atelocollogen for two days.Cartilage defects were created in both keen joint of twenty-six rab- bits.Complexes of chodrocytes and atelocollagen was grafted into the defect of left knee joint at once as experi- mental group,and no implantation were served as control.General and histological examination were respec- tively performed in both group at four weeks and eight weeks after surgery.Results After implantation,the defects were filled with cartilaginous tissue in experiment group,while there were only tissue in control group. Histologically,defective areas were filled with chondrocytes in experiment group,but only fibroblast in control group.Conclusion The implantation of the tissue engineered cartilages contenting with chondrocytes and atelocollogen can effectively improve reconstruction of rabbit knee joint.

Objective To investigate the feasibility and effects of endoscopic surgical treatment of lumbar intervertebral disc herniation associated with veitebral osteochondrosis.Methods From June 2008 to December 2015,276 cases of lumbar intervertebral disc herniation associated with vertebral osteochondrosis were treated with endoscopic surgery,including 185 men and 91 women,with an average 39.2 years old (range,16-65 years old).The involved level included L2.3 in 2 cases,L3.4 in 9 cases,L4,5 in 126 cases and L5S1 in 139 cases.On preoperative axial CT,the diameter of ossification was more than half of the transverse or sagittal diameter of the spinal canal in 89 cases,and no more than half of the transverse and sagittal diameter of the spinal canal in 187 cases.All patients were operated on the side with serious symptom,181 cases were operated with mobile microendoscopic discectomy (MMED),and 95 cases were operated with percutaneous endoscopic surgery,including percutaneous transforaminal endoscopic discectomy (PTED) in 61 cases and the percutaneous interlaminar endoscopic discectomy (PIED) in 34 cases.The operation and complications were analyzed.Results The soft herniation,broken disc material and the periphery of compressing ossification were removed under the endoscope in all cases,until the nerve was well decompressed.However,the ossification was not complete resected.Dural sac tear occurred in 3 cases of MMED.In the early stage of PTED,2 cases converted to MMED because of intraoperative pain and difficulty,and one case had exiting nerve root injury.At the final follow-up of 12-60 months (average,20.6 months),visual analogue scale decreased from preoperative 8.5±1.2 to 1.0±0.9,Oswestry disability index decreased from preoperative 40.2±8.6 to 3.1±3.0.According to Macnab scale,the results were excellent in 89,good in 154 cases,moderate in 33 cases.Conclusion For most lumbar intervertebral disc herniation associated with vertebral osteochondrosis,good results can be achieve by removal of herniated and broken intervertebral disc and decompression of nerve with endoscope.Therefore,we speculate that the soft disc herniation and spinal stenosis are main pathogenic factors,and that the complete resection of ossification is not needed.

Objective To provide a minimally invasive surgical treatment using mobile microendoscopy (mobile MED) for limited cervical spine canal stenosis. Methods Eleven patients were collected from February 2015 to February 2016 in Tianjin Hospital, including 6 males and 5 females, aged 51- 77 years, mean (67.4 ± 7.6) years. Clinical treatment was performed on 11 patients of limited cervical spinal stenosis. The levels of stenosis included C3-5 in 5 cases, C4-6 in 4 cases, C5-7 in 2 cases. The working channel of mobile MED (MMED) can be tilted according to the need of operation. The design of surgical methods:the levels of stenosis were located with fluroscopy, through a posterior median 2.5 cm incision, the nachal ligaments was separated and the spinous process was reached. After a little dissection of paraspinal mascle, the working canal was inserted along the spinous process, and the target lamina was exposed. With MMED, the partial laminectomy was performed along the junction groove of lamina and articular process with high-speed burr, and flavum was exposed and resected with ultra-thin Kerisson, and the dural sac was well exposed. Then the working canal was inserted on the contralateral side along the spinous process, and the decompression was performed with the same method. After bilateral direct decompression, the spinous process and posterior ligament complex shift posteriorly with enlargement of spinal canal. The operation time and blood loss were recorded and the efficacy was followed-up. Results There was no serious complications such as neurological injury. The operation time ranged 80-120 min, with an average of (100 ± 18) min. The intraoperative blood loss ranged (50-120) mL, with an average of (80 ± 20) mL. Postoperative CT showed sufficient decompression and enlargement of the canal with the posterior shift of the spinous process and posterior ligament complex. The patients were followed up for 6-18 months. The alignment of cervical spine was well preserved on X-ray. The ODI decreased from 42.2 ± 16.3 preoperatively to 6.2 ± 4.3. The JOA score improved from 8.2 ± 3.3 preoperatively to 15.1 ± 4.2 at the last follow-up. According to the improvement rate [(JOA-preoperative JOA)/(17-preoperative JOA)], the results were excellent in 5 cases, good in 5 cases, and effective in 1 case. Conclusion The cervical canal enlargement with mobile microendoscopic discectomy technique preserving posterior ligament composite provides a minimally invasive procedure for limited cervical stenosis with adequate decompression.

Objective To analyze the value of mini-open approach beside costodiaphragmatic recess in thoracolumbar spine surgery. Methods This approach was applied in 31 anterior thoracolumbar spine surgeries, including 22 men and 9 women, with a mean age of 41 years old (range, 26-58 yrs). The diagnosis were burst fractures in 27 cases (T12 level in 12 cas?es and L1 level in 15 cases) and disc herniations with osteochondrosis in 4 cases. An antero-lateral 10-15 (average is 12) cm incision was performed, then the 11th rib was resected and the extraperitoneal space below diaphragma was disconnected. The pleura fold was identified beneath the rib bed, so the gap beside the costdiaphragmatic recess was entered through an in?cision beyond the fold. The diaphragm and medial arcuate ligament were clipped and vertebral body from T11 to L2 were ex?posed. Results The lateral side of T11 to L2 vertebral body was sufficiently exposed in all the 31 patients. In 26 patients, the pleura fold was beyond the bed of the 11th rib, so the 11th intercostals vessel and nerve were exposed and protected, and the costodiaphragmatic recess was reached through the superior border of the 12th rib. Laceration of pleura occurred in 4 cases af?ter it was sutured, but the extra-pleura approach could still be used after repairing without invading into thorax. Fixation and fusion were performed from T11 to L2. Complications include intercostals nerve pain were seen in 3 cases, which resolved with conservative treatment. Conclusion The mini-open approach beside costodiaphragmatic recess can be used in anterior thoraclumbar spine surgery with sufficient explosion and minimum injury in which thoracic cavity.

Objective To analyze laparoscopic lymphadenectomy and the safety of gastrectomy for gastroesophageal junction cancer.Methods From Jan 2011 to Dec 2012 72 gastroesophageal junction cancer patients were enrolled, including 46 patients in laparoscopic group, and 26 in open surgery group.Results There was no significant difference in the numgbers of lymph node dissection between the two groups and nor difference in the number of positive lymph node dissection.Esophagus resection length in open group was (2.0 ± 1.0) cm, while that was (3.0 ± 0.8) cm in laparoscopic group (t =0.471, P ＜ 0.001).5 (19％)patients in open group had positive margins compared to six in laparoscopic group (13％), x2 =0.491, P =0.483.7 patients in the open group underwent thoracoabdominal resection, while in laparoscopic group 3 patients did, x2 =5.781, P =0.016.Laparoscopic splenic hilar lymphnodes dissection harvested more lymph nodes (t =0.260, P =0.011).Laparoscopic gastrectomy used less operation time (t =0.237, P =0.021) experinced less blood loss (t =0.451, P ＜ 0.01) than open group.There was no difference in major complications between the two groups.Conclusions Laparoscopic splenic hilar lymphnodes dissection in gastroesophageal junction cancer surgery is superior to open surgery, with more lymph nodes harvested, longer esophageal cutting distances, lower incidence of thoracoabdominal surgery, shorter operation time, and less blood loss.