BACKGROUND:Thoracolumbar fracture often accompanies with the injury of adjacent intervertebral disc. Traditional posterior short-segment fixation does not deal with the injured intervertebral disc, which may be the main reason for kyphosis in patients after surgery.
OBJECTIVE:To investigate the effect of injured intervertebral disc on kyphosis angle in patients with single vertebral thoracolumbar fracture after treated with posterior short-segment fixation alone.
METHODS:From January 2009 to June 2014, 40 cases of thoracolumbar fractures were treated in Jinan Central Hospital. They were folowed-up at preoperation, 2 and 12 months after operation and 6 months after internal fixation removal. Data were obtained from X-ray and MRI scanning. According to the preoperative MRI images, cases were assigned to observation group (17 cases) and control group (23 cases) according to injury and non-injury intervertebral disc. Data of vertebral wedge angle, sagittal plane kyphosis, proximal intervertebral disc angle, sagittal index and degeneration classification of proximal intervertebral disc angle from two different groups were analyzed at each folow-up time point (18-30 months, averagely 23.6 months).
RESULTS AND CONCLUSION:(1) Imaging parameters: sagittal plane kyphosis was significantly severer at 6 months than that at 2 months in both groups (P < 0.05). Sagittal plane kyphosis, proximal intervertebral disc angle and sagittal index were greater in the observation group than in the control group at 12 months after surgery and 6 months after fixator removal (P < 0.05). (2) Degeneration classification of proximal intervertebral disc angle: Pearce degeneration grade of proximal intervertebral disc was significantly higher in the observation group than in the control group at 2 months after surgery and 6 months after internal fixation removal (P < 0.05). (3) Results suggested that kyphosis may appear in the patients with thoracolumbar fracture after a posterior short-segment fixation alone, and the injured disc may lead to more severe kyphosis.

Streptococcus dysgalactiae subspecies equisimilis (SDSE) belongs to group C or group G β-hemolytic Streptococcus, SDSE infection cases are mostly related with the consumption of contaminated dairy or meat products, the major symptom is upper respiratory tract infection, and is easily to be misdiagnosed.In June 2014, an outbreak of acute upper respiratory tract infection due to SDSE occurred in a kindergarten in Xi'an City.All cases were followed up, the initial case developed as latent nephritis, the main cause for the development of latent nephritis was not performing diagnosis and treatment timely.In order to enhance the understanding of the epidemiological and clinical features of SDSE infection, strengthen prevention and control ability, and reduce the occurrence of adverse sequelae, investigation of the case and epidemic situation should be reported.

ObjectiveTo observe the effects of psychological intervention on anxiety, depression, and postoperative cardiovascular complications in adult patients with lung cancer. Methods96 patients (aged ≤55 years) with lung cancer and undergoing thoracic operation were divided into intervention and control groups. The control group was only given routine care advice and health education, while the intervention groups was combined with various psychological intervention before and after operation. All the patients were assessed with self-rating of anxiety and depression scale (SAS, SDS) and the blood pressure were measured at admission, 1 d before operation, 5 d after operation, and the heart were monitored pre- and post-operation. ResultsThe SAS, SDS score, and blood pressure were not statistically significant between two groups at admission, but significant 1 d before operation and 5 d after operation. The incidence of cardiovascular complications was significantly different after operation (P<0.05). ConclusionThe individual psychological intervention can reduce the anxiety and depression, stabilize blood pressure, and decrease the incidence of cardiovascular complications in adult lung cancer patients undergoing thoracic operation.

Objective To study the association of the expression of bone morphogenetic protein (BMP) antagonist gremlin and vascular calcification in radial arteries of patients with stage 5 of chronic kidney disease (CKD).Methods Radial arteries of 40 patients with stage 5 of CKD were collected as specimens of the study group,which were trimmed off during arterial venous fistula operations.Splenic trabecular arteries were collected as specimens of the control group,which were removed from 38 patients with simple traumatic splenic rupture.All the arteries were examined histologically for calcification with yon Kossa stain.Expressions of gremlin and BMP-2,-7were detected by immunohistochemistry and their serum concentrations were detected by ELISA.Images of histological sections were semi-quantitatively analyzed by Image-Pro Plus 6.0.SPSS 19.0software was used to perform statistical analysis.Results Significantly positive von Kossa stain was found in radial arteries from 12 of 40 patients (30％) in study group,which located in the layer of medial smooth muscle cells.However,there was no obvious positive stain in control group.Additionally,in study group,significant expressions of gremlin and BMP-2 were detected in those radial arteries of positive yon Kossa stain,which also located in the layer of medial smooth muscle cells.Positive correlations were found among gremlin expression level,BMP-2 expression level and yon Kossa stain intensity.However,the BMP-7 expression intensity in arteries of study group was much weaker as compared to control group.Conclusions Both gremlin and BMP-2 may be involved in the process that the smooth muscle cells of radial arteries in patients with stage 5 of CKD phenotypically transform into osteoblast-like cells.However,BMP-7 possibly prevents this process.

OBJECTIVETo evaluate the outcome of Titanium elastic intramedullary nailing (TEN) for the treatment of displaced midclavicular fractures.

METHODSBetween February 2010 and February 2013, 62 patients with displaced midclavicular fractures were treated by TEN, including 27 males and 35 females with an average age of 37.6 years old ranging from 15 to 67 years. The course of disease was from 1 to 9 days (means 2.7 days). Thirty-nine cases were treated by closed reduction and 23 cases by assistant small incision. Based on OTA (the Orthopaedic Trauma Association classification) classification, 31 cases of simple fractures involved 5 cases of 06-A1,15 cases of 06-A2,11 cases of 06-A3; 31 cases of wedge fractures involved 4 cases of 06-B1,12 cases of 06-B2,15 cases of 06-B3. Postoperative pain relief were evaluated by VAS score,and operation time,fracture healing time were recorded. After 6 weeks and after removing internal fixation shoulder joint function was evaluated by Constant score, and shoulder joint function were assessed by Herscovici score after 6 weeks.

RESULTSExcept 2 cases were lost to follow-up, 2 cases did not remove internal fixation, 3 cases' fractures were nonunion, the remaining 55 patients received follow-up for an average time of 11.4 months. The average preoperative VAS score was 5.20±0.71, and it turned to be 1.550.59 at 3 days after operation. The average operative duration was 40 min (15 to 65 min). The average bone healing time was (2.71±0.54) months (2 to 5 months). No difference about bone healing time was found between simple fractures and wedge fractures,and between the patients treated by closed reduction and assistant small incision. According to Herscovici standard, the shoulder function was excellent in 49 cases, good in 4, fair in 1, and poor in 1. Simple fractures achieved better Constant score than wedge fractures at 6 weeks postoperatively, whereas no difference was found at 4 weeks after fixation removal.

CONCLUSIONTitanium elastic nails (TEN) for treatment of displaced midclavicular fractures has advantages of good clinical effect,rapid pain relief,fast recovery of shoulder joint function. For OTA classification type B patients with comminuted fracture can replace steel to achieve very good effect, but to grasp the appropriate.

Adolescent ; Adult ; Clavicle ; injuries ; surgery ; Female ; Fracture Fixation, Intramedullary ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged

OBJECTIVETo explore clinical results of open reduction and internal fixation (ORIF) for posterior Pilon fracture through posterolateral approach.

METHODSSeventeen patients with posterior Pilon fracture were treated through posterolateral approach from February 2010 to April 2013. Among them,including 11 males and 6 females aged from 29 to 59 with an average of 43.4 years old. All fractures were associated with more than 20% of articular surface of distal tibial. The causes of injury included falling down (11 cases), traffic accident (4 cases) and sports injury(6 cases). Fracture classification was based on posterior pilon fracture by YU Guang-rong, including type I (6 cases), type II (2 cases) and type III (6 cases). Fracture healing time, fracture reduction and postoperative complications were observed, AOFAS score were applied to evaluate clinical efficacy.

RESULTSAll patients were followed up from 13 to 24 months with an average of 20.5 months. All incisions were healed at stage I, and fractures obtained healing,the time of fracture healing ranged from 12 to 21 weeks with an average of 15.2 weeks. No incision infection, neurovascular injury, bone ununion and fracture deformity were found after operation. Postoperative AOFAS score was 92.0 ± 10.2, and 14 cases got excellent results, 2 good and 1 moderate.

CONCLUSIONPosterior pilon fracture through posterolateral approach could obtain effective reduction, stable fixation. It is a safe, simple and effective operation for treating posterior Pilon fracture, and it is worth popularizing.

Adult ; Ankle Fractures ; surgery ; Ankle Joint ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

Objective To investigate the effects of miRNA-146a on the differentiations and functions of CD4+ T lymphocytes in patients with psoriasis vulgaris.Metbods Thirty patients with psoriasis vulgaris and twenty heathy subjects were enrolled in this study.Quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to detect the expression of miRNA-146a in CD4+ T lymphocytes isolated from the peripheral blood samples.The levels of IFN-γ and IL-4 in serum samples were determined by using enzyme-linked immunosorbent assay (ELISA).Mononuclear cells were isolated from human peripheral blood samples by using Ficoll-Hypaque density-gradients centrifugation,from which the CD4+ T lymphocytes were separated by magnetic-activated cell sorting.The CD4+ T cells (2× 106/ml) were seeded in culture plates with 6 wells.The CD4+ T lymphocytes were divided into 3 groups including the control group,miRNA-146a group and miRNA-146a inhibitor group.The numbers of Th1 and Th2 cells were measured by flow cytometry analysis (FACS).The expression of IFN-γRα,T-bet and GATA-3 at mRNA and protein levels were measured by using RT-PCR and Western blot assay,respectively.The levels of IFN-γ and IL-4 in culture supernatants of CD4+ T lymphocytes were detected by using ELISA.Results In comparison with the normal control group,there were significant increases in the expression of miRNA-146a in CD4+ T lymphocytes and the level of IFN-γin serum samples from patients with psoriasis vulgaris [(2.43±0.94) vs (1.05±0.23),(27.69±7.64) ng/L vs (9.75±2.81) ng/L,all P＜0.01].A positive correlation between the expression of miRNA-146a and the level of IFN-γ in serum was observed (r=0.837,P＜0.01).Results of the in vitro culture of CD4+ T lymphocytes showed that the number of Th1 cells,the expression of T-bet at mRNA and protein levels and the level of IFN-γin culture supernatant were significantly increased,while the expression of IFN-γRα protein was decreased in the miRNA-146a group in comparison with those of the control group (all P＜0.01).No significant differences in the number of Th2 cells,the expression of GATA-3 protein,the expression of GATA-3 and IFN-γRα at mRNA level and the level of IL-4 in culture supernatants were found between the control and miRNA-146a groups (all P＞0.05).The miRNA-146a inhibitor could effectively attenuate the effects of miRNA-146a on Th1 cells.Conclusion The miRNA-146a could promote the differentiation and enhance the function of Th1 cells.It might play an important role in the pathogenesis of psoriasis vulgaris.

Objective To evaluate changes of Rho kinase (ROK)activity in peripheral blood T lymphocytes from patients with atopic dermatitis (AD), and to analyze their clinical significance. Methods Eight milliliters of heparin-anticoagulated blood samples were collected from 60 patients with AD and 60 healthy human controls followed by separation of T lymphocytes and sera from these blood samples as well as culture of isolated T lymphocytes with 10% fetal bovine serum for 24 hours. Both patient- and control-derived T lymphocytes were classified into two groups to be cultured with patient- or control-derived sera. In addition, some patient-derived T lymphocytes were classified into 4 groups:Y27632 group treated with the Rho kinase-specific inhibitor Y2763, CD3/CD28 group treated with anti-CD3/anti-CD28 monoclonal antibodies, Y27632 + CD3/CD28 group treated with Y27632 and anti-CD3/anti-CD28 monoclonal antibodies, and control group treated with patient-derived sera. Subsequently, Western-blot analysis was performed to evaluate ROK activity in cells, methyl thiazolyl tetrazolium(MTT)assay to evaluate proliferative activity of T lymphocytes, and ELISA to measure interleukin 6 (IL-6)and IL-10 levels in supernatants of T lymphocytes. Results ROK activity was significantly lower in fresh T lymphocytes from patients than in those from healthy controls (2.47% ± 0.89% vs. 0.65% ± 0.35%, t =2.729, P < 0.05). After 24-hour culture with 10% fetal bovine serum in vitro, ROK activity was significantly decreased in patient-derived T lymphocytes compared with those before culture (0.70% ± 0.38% vs. 2.47% ± 0.89%, t = 2.658, P <0.05), but no significant difference was observed between patient- and control-derived T lymphocytes(0.70% ± 0.38% vs. 0.63% ± 0.32%, t = 1.010, P > 0.05). Compared with T lymphocytes cultured with control-derived sera, those cultured with patient-derived sera showed significantly increased ROK activity (F = 8.22, P < 0.001). Concretely speaking, ROK activity was significantly higher in patient-derived T lymphocytes cultured with patient-derived sera than in those cultured with control-derived sera (2.41% ± 0.87% vs. 0.76% ± 0.41%, P < 0.05), and higher in control-derived T lymphocytes cultured with patient-derived sera than in those cultured with control-derived sera(2.17% ± 0.85% vs. 0.64% ± 0.33%, P< 0.05)at 24 hours. Y27632 could significantly inhibit the proliferation of as well as secretion of IL-6 (F = 18.68, 22.95, respectively, both P < 0.001)by patient-derived T lymphocytes, but had insignificant effects on secretion of IL-10. The cellular proliferative activity and IL-6 supernatant level were significantly lower in the Y27632 group than in the control group, and lower in the Y27632 + CD3/CD28 group than in the CD3/CD28 group (all P < 0.05). Conclusion Aberrant activation of ROK exists in T lymphocytes from patients with AD, which may play a certain role in the pathogenesis of AD.

Objective To evaluate regulatory effects of miRNA-146a on peripheral blood CD4 + T lymphocytes from patients with psoriasis vulgaris, and to investigate the role of miRNA-146a in the pathogenesis of psoriasis vulgaris. Methods Totally, 30 patients with psoriasis vulgaris and 30 healthy human controls were enrolled into this study. Venous blood samples were obtained from these subjects, and CD4 + T lymphocytes were isolated from these samples by using magnetic activated cell sorting (MACS). Real-time quantitative PCR (RT-PCR)was performed to measure the expression of miRNA-146a in peripheral blood CD4+ T lymphocytes, and enzyme-linked immunosorbent assay(ELISA)to determine plasma levels of interferon-γ(IFN-γ)and interleukin 4(IL-4). Some CD4+ T lymphocytes were divided into 3 groups to be transfected with 50 nmol/L negative control miRNA (control group), miRNA-146a mimics(miRNA-146a group)or miRNA-146a inhibitor (miRNA-146a inhibitor group). After 24-hour additional culture, flow cytometry was conducted to determine the number of Th1 and Th2 cells, Western-blot analysis and RT-PCR were performed to measure the protein and mRNA expressions of IFN-γ receptor α (IFN-γRα), T-box expressed in T cells (T-bet)and GATA-binding protein-3 (GATA-3)respectively, and ELISA was carried out to determine the levels of IFN-γ and IL-4 in supernatants of CD4 + T lymphocytes. Results Compared with the healthy control group, the patient group showed significantly increased miRNA-146a expression in peripheral blood CD4 + T lymphocytes (243.81% ± 94.32% vs. 105.74% ± 22.93%, t = 6.653, P < 0.01)and plasma IFN-γ level (27.69 ± 7.64 ng/L vs. 9.75 ± 2.81 ng/L, t = 4.237, P <0.01). Moreover, miRNA-146a expression was positively correlated with plasma IFN-γ level in the patients(r = 0.837, P <0.01). After 24-hour culture in vitro, there was a significant increase in the number of Th1 cells, protein and mRNA expressions of T-bet, and supernatant level of IFN-γ, but a significant decrease in the protein expression of IFN-γRα in the miRNA-146a group compared with the control group (all P < 0.01). However, no significant differences were observed in the number of Th2 cells, mRNA or protein expressions of GATA-3, or supernatant level of IL-4 among the control group,miRNA-146a group and miRNA-146a inhibitor group (all P > 0.05). Conclusion miRNA-146a may play an important role in the pathogenesis of psoriasis vulgaris by participating in the regulation of peripheral blood CD4+ T lymphocytes via affecting Th1 cell differentiation and function.

Objective To study the activation of alveolar macrophage β (AM) and the expression of co-stimulatory molecule CD40 in transfusion-related acute lung injury (TRALI) model in order to illustrate the pathogenesis of TRALI.Methods Sixty SD rats were randomly (random number) divided into normal control group (n =15) with sham operation using normal saline instead of LPS and plasma,positive control group (n =15) with ALI induced by intravenous infusion of 5 mg/kg lipopolysaccharide (LPS) in equivalent volume of whole blood drawn out),and TRALI group (n =15) treated by intra-peritoneal injection of 2 mg/kg LPS 2 h before the transfusion of human plasma (1 mL whole blood about 10％ of total blood volume drawn out and replaced with 1 mL plasma),LPS control group (n =15) treated by intra-peritoneal injection of 2 mg/kg LPS 2 h before saline infusion in equivalent volume of blood drawn out.The pathologic changes of rat lung tissue were observed by HE staining.The expression of TLR4 was examined by RT-PCR.The activation of NF-κB in AM was measured by electrophoresis mobility shift assay (EMSA).The expression of CD40 mRNA and CD40 molecule were analyzed by Northern blot and flow cytometry respectively.ELISA was performed to detect the concentration of TNF-α,MIP-2 and IL-1 β in broncho-alveolar lavage fluid (BALF).Results Broken alveolar septa,hyperemia,and massive infiltration of inflammatory cells including the neutrophils were observed in lung tissues of TRALI group.The expression of TLR4 gene was detected in activated macrophage phi (AMφ) of TRALI group rats.The activation of NF-κB was increased in TRALI group rats.The expression of CD40 in AMφ was higher in rats of TRALI group than that in rats of control group and LPS control group.The concentration of TNF-αt,MIP-2 and IL-1β were enhanced significantly in BALF of TRALI group rats.Conclusion The activation of AM and up-regulation of costimulatory molecule CD40 induced release of some inflammatory cytokines.It suggested that AM activation may play an important role in the pathogenesis of TRALI.