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.

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

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 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 estimate the activity of the phosphatidylinositol3-kinase (PI3K) signaling pathway in peripheral blood T cells from patients with atopic dermatitis (AD),and to investigate its clinical significance.Methods T cells were isolated by using the Rosettsep T cell purification kit from the peripheral blood of 38 patients with AD and 38 healthy human controls,and classified into several groups to be treated with anti-CD3 monoclonal antibody,anti-CD28 monoclonal antibody,and LY294002 (an inhibitor of PI3K) respectively.The activity of PI3K signaling pathway in T cells was estimated by immunoprecipitation and enzyme-linked immunosorbent assay (ELISA).Western blot was performed to measure the expressions of total Akt and phosphorylated Akt in T cells,methyl thiazolyl tetrazolium (MTT) assay to examine the proliferation of T cells,and ELISA to determine the levels of interleukin 6 (IL-6) and IL-10.Results The activity of PI3K and Akt was significantly higher in freshly isolated patient-derived T cells than in control-derived T cells (both P ＜ 0.05).However,the difference in the activity of PI3K and Akt between patient-derived and control-derived T cells disappeared (both P ＞ 0.05) after 24-hour in vitro culture.The activity of PI3K and Akt in control-derived T cells was significantly increased after 24-hour incubation with sera from the patients with AD (both P ＜ 0.05).In addition,compared with patient-derived T cells treated with patients' sera or anti-CD3/CD28 monoclonal antibody alone,those treated with the combination of LY294002 and patients' sera or anti-CD3/CD28 monoclonal antibody showed a significant decrease in the proliferative activity (63％ ± 11％ vs.123％ ± 25％,125％ ± 22％ vs.195％ ± 28％,both P＜ 0.05),supematant levels of IL-6 ((168 ± 33) vs.(265 ± 46) ng/L,(431 ± 64) vs.(823 ± 128) ng/L,both P＜ 0.05) and IL-10 ((56 ± 14) vs.(98 ± 25) ng/L,(120 ± 21) vs.(213 ± 35) ng/L,both P＜ 0.05).Eczema area and severity index (EASI) was unassociated with the activity of PI3K or Akt in fresh T cells from patients with AD (both P ＞ 0.05).Conclusions The PI3K signaling pathway is abnormally activated in peripheral blood T cells from patients with AD,which is associated with the proliferation of,as well as secretion of cytokines by,T cells,suggesting that there exist serum factors activating this pathway in peripheral blood of patients with AD.

ObjectiveTo prepare a novel etimicin-encapsuled chitosan/hydroxyapatite nano-scaffolds and offer assistances for bone defect or osteomylitis.MethodsDrug-carried chitosan nanoparticles which was prepared by ionotropic gelation were combined with nano-hydroxyapatite.The mixture were shaped in molds and then prepared into porous scaffolds by freeze-dry.The surface of one scaffold was scanned.The grinded,particles of the scaffold were detected by field emission scanning electron microscope; X-ray diffraction was used to analyze components of the scaffold and total porosity.Staphylococcus aureus was choosed as the experimental bacteria,we studied lasting antibacterial property of drug-carried bone scaffold by antibacterial experiments,long-term drug releasing experiments and accumulation drug releasing experiments.Bone mesenchymal stem cells were used to detect the histocompatibility and inductivity of etimicin-carried scaffold.ResultsFreeze-dried porous scaffold has a surface with proper pore distribution (total porosity 70.68％) and the grinded scaffold has a globular and coliformed microstructure known after scanned by electron microscope.The drug-carried scaffold has a typical wave of hydroxyapatite under X-ray diffraction.The lasting antibacterial property study indicated that the drug-carried bone scaffold had maintained an inhibition zone for more than 7 days.The long-term drug releasing experiments and accumulation drug releasing experiments show that the fictional drug-carried bone scaffold released above the bacteriostasis concentration after one week and the accumulative amount within the safety scale.The scaffold had not an inhibitory effect on bone mesenchymal stem cells.ConclusionThe etimicin-encapsuled chitosar/ hydroxyapatite nano-scaffolds has similar microstructure and components of bone tissue.It is promising in bone tissue engineering applications because of its slow-release,antibacterial properties and satisfactory histocompatibility.

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.

Objective To explore the effects of low dose amitriptyline (AMT) on gastrointestinal function and its adverse effects in healthy volunteers.Methods In this randomized,double-blind,placebo-controlled cross-over study,28 healthy volunteers were divided into AMT with placebo group (n=14) and placebo with AMT group (n=14).The former took AMT for seven days at first stage,followed with a 14 days wash out stage and then took placebo for seven days at second stage.Patients of the latter group took medication in reverse order.The dose of medication was 12.5 mg three times per day.The subjects underwent drinking-ultrasonography test and lactulose hydrogen breath test before taking medication and between the seventh and eighth day of first and second stage.The data were analyzed by two stages cross-over analysis,Wilcoxon signed-rank test and chi-square test.Results The results of drinking-ultrasonography test showed that there were no significant differences in proximal gastric cross-sectional area between AMT and placebo after drinking 200,400,600 and 800 mL water (all P＞ 0.05).After drinking 800 mL water,there were no significant differences in gastric liquid emptying rate between AMT and placebo at the fifth and the tenth minutes (both P＞0.05).After drinking 600 mL and 800 mL water,the visual analogue scale (VAS) of AMT was significantly lower than that of placebo (2.98±0.85 vs 3.57±0.94,Z=4.412,P＜0.01; 4.57±0.98 vs 5.57±0.82,Z=4.170,P＜0.01).The results of lactulose hydrogen breath test revealed that orocecal transit time of AMT was obviously longer than that of placebo ((109.29±29.68) min vs (96.61±23.90) min,F=9.918,P＜0.01)).The common adverse effects were mild sleepiness,bitter taste and dry mouth.Conclusions Low dose AMT can prolong orocecal transit time and improve gastric sensitivity,but can not significantly affect proximal gastric accommodation and gastric liquid emptying.The adverse effects are mild and the safety is good.