Objective To analyze the clinical results and early complications of corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation via a single posterior approach for severe thoracic and lumbar fractures.Methods Forty-four patients treated by reconstruction with titanium mesh cage implantation and pedicle screw fixation via a single posterior were studied retrospectively.There were 35 males and 9 females,with an average age of 37.3 years(range,19-66 years).The injury segments include 1 case at T11,5 cases at T12,20 cases at L1,11 cases at L2,5 cases at L3 and 2 cases at L4.According to AO classification,there were 24 cases of A3,17 cases of B1 and B2,and 3 cases of C1.According to ASIA,there were 10 cases of grade A,17 cases of grade B,10 cases of grade C and 7 cases of grade D.The neurologic function and effectiveness of correction of preoperative,immediate postoperative and 2years follow-up were compared,and the clinical outcome and early complications were analyzed.Results The follow-up time was 24 to 58 months,mean 38.9 months.At the time of 2 years postoperation,43 cases of incomplete neurologic deficit had improved 1 or 2 ASIA grades except 1 case of grade A.The results of decompression and reduction were satisfactory from the postoperative radiographic examinations.The correction maintained well and the implant loosening was not seen in 43 cases(97.7%)at the last follow-up.The com plications include:excessive blood loss(＞1500 ml)in 9 cases,transient nerve root injury in 4,cerebrospinal fluid leakage in 3,instrumentation failure in 1,mesh cage malposition in 3,iatrogenic leaving of free bone granula into the canal in 2,and superficial infection in 1.Conclusion This technique is effective for decompression and fusion,less invasive than combined anteroposterior procedure,and may be another good alternative for the treatment of severe thoracic and lumbar fractures.The early complications are not rare,but most of them are not serious and are relative to techniques.

Objective To study the expressions and clinical significances of activating transcription factor 3 (ATF3) and Runt-related transcription factor 2 (Runx2) in breast carcinoma tissues.Methods The expressions of ATF3 and Runx2 were detected in 105 cases of primary breast invasive ductal carcinoma (IDC) and their matched para-tumor breast tissues by immunohistochemistry.The relationships between the two transcription factors and the clinical pathological features of IDC patients were analyzed.Results The positive expression rates of ATF3 and Runx2 in IDC group were 80.95％ (85/105) and 69.52％ (73/105) respectively,much higher than those in para-tumor breast tissues 11.43 ％ (12/105) and 8.57％ (9/105),with statistically significant differences (x2 =102.097,P =0.000;x2 =11.595,P =0.001).ATF3 and Runx2 expressions showed significant relationships with histological grade (x2 =14.623,P =0.001;x2 =24.891,P =0.000),lymph node metastasis (x2 =7.059,P =0.008;x2 =6.358,P =0.012) and pTNM stage of IDC (x2 =5.807,P =0.016;x2 =4.902,P =0.027),while both were not correlated with patients' age (x2 =0.274,P =0.601;x2 =1.554,P =0.213) and tumor size (x2 =2.476,P =0.290;x2 =5.261,P =0.072).There was a significant positive relationship between ATF3 and Runx2 in breast carcinoma (C =0.498,P =0.000).Conclusion The over-expressions of ATF3 and Runx2 may participate in the tumorigenesis,invasion,metastasis and clinical stage of breast carcinoma,which suggests that they may be key factors to evaluate malignant degree and prognosis of breast carcinoma.

BACKGROUNDHerpes simplex keratitis (HSK) caused by herpes simplex virus 1 (HSV-1), which has high recurrent rate and incidence of severe vision loss, is the leading cause of infectious blindness in the world. The aim was to explore the clinical efficacy of oral ganciclovir (GCV) in the prevention of recurrent HSK.

METHODSA multicenter, prospective, randomized, single-blind, and controlled clinical trial was conducted from April 2010 to June 2013. One hundred seventy-three patients (173 eyes involved) who were diagnosed as recurrent HSK definitely, including stromal keratitis and corneal endotheliitis, were divided into three groups randomly: negative control (placebo) group was topically administered with 0.15% GCV ophthalmic gel, 4 times per day and 0.1% fluorometholone eye drops, 3 times per day until resolution of HSK; positive control acyclovir (ACV) group was topically adopted the same ophthalmic gel and eye drops and additionally received oral ACV 400 mg 5 times a day for 10 weeks and followed by 400 mg 2 times per day for 6 months; test GCV group was topically adopted the same treatment as negative control group and additionally received oral GCV 1000 mg 3 times per day for 8 weeks. The symptoms and signs were evaluated before and after the therapy 1 st week, 2 nd week and then followed up every 2 weeks until recovery. Furthermore, we followed up recurrence of HSK for every 3 months after recovery and then assessed the cure time, recurrent rate and adverse reactions.

RESULTSOne hundred and seventy-three patients were followed up 7-48 months (mean 32.1 ± 12.3 months), but 34 patients were failed to follow-up. The cure time was 12.1 ± 4.3, 11.9 ± 4.0 weeks in negative control (placebo) group and positive control ACV group respectively (P = 0.991), which was longer than that in test GCV group (8.6 ± 2.8 weeks) and there was a significant difference between test GCV group and negative control (placebo) group or positive control ACV group (P = 0.000). Furthermore, the recurrent rate was higher in negative control (placebo) group (47.3%) than that in positive control group ACV (26.7%) and test GCV group (17.2%), and there was a great significant difference among the three groups (P = 0.007), but there was no significant difference between positive control ACV group and test GCV group (P = 0.358). In addition, there was no obvious adverse reaction expect neutropenia (only one patient in test GCV group).

CONCLUSIONShort-term oral GCV could cure recurrent HSK and endotheliitis, shorten the course, reduce recurrent rate of HSK and have confirmed safety.

Adult ; Aged ; Antiviral Agents ; administration & dosage ; therapeutic use ; Female ; Ganciclovir ; administration & dosage ; therapeutic use ; Humans ; Keratitis, Herpetic ; drug therapy ; Male ; Middle Aged ; Single-Blind Method ; Treatment Outcome

OBJECTIVETo test expression of carbonic anhydrase II (Ca II) mRNA in osteoclasts which were applied with fluid shear stress.

METHODSThe bone marrow cells of Sprague-Dawley rats were cultured with the presence of 1,25-(OH)2D3 and dexamethasone. The osteoclast-like cells were identified by tartrate-resistant acid phosphatase(TRAP) staining and scanning electron microscope (SEM) observation, then purified with trypsin/ethylenediamine tetraacetic acid (EDTA). Different values and lasting time of steady fluid shear stress were exerted on the osteoclasts with parallel plate flow system. The Ca II expression of osteoclasts were detected by real time reverse transcription-polymerase chain reaction(RT-PCR) and nested polymerase chain reaction(PCR).

RESULTSThe levels of Ca II mRNA were down-regulated correspondingly with the increase of stress and time (P < 0.05).

CONCLUSIONIt's indicated that steady fluid shear stress within a certain range may down-regulate the expression of Ca II in osteoclasts.

Animals ; Bone Marrow Cells ; Carbonic Anhydrase II ; Cells, Cultured ; Osteoclasts ; Polymerase Chain Reaction ; RNA, Messenger ; Rats ; Rats, Sprague-Dawley ; Stress, Mechanical

Objective:To report 1 case of mushroom poisoning complicated with multiple organ dysfunction syndrome treated by liver transplantation, so as to explore surgical effectiveness and prognosis of liver transplantation on children mushroom poisoning.Methods:Retrospectively analyzed a child with mushroom poisoning who was admitted to the First Affiliated Hospital of Zhengzhou University in June 2017.Conventional treatment was not ideal, the child was conducted orthotopic liver transplantation.The effectiveness was evaluated and the feasibility of liver transplantation in treating children mushroom poisoning with literatures was reviewed.Results:A male 2-year old child obtained, preo-perative Child-pugh class for C. This child recovered well postoperatively, the jaundice disappeared, and liver enzyme and blood coagulation function improved significantly within 1 week after liver transplantation.However, the head magnetic resonance imaging presented brain atrophy and ventricular expansion, with intelligence and athletic ability being significantly behind his peers through postoperative regular follow-up for 2 years.Conclusion:Fulminant hepatic failure that was caused by mushroom poisoning is an indication for liver transplantation, and orthotopic liver transplantation is an effective method for the treatment of mushroom poisoning, which can effectively improve liver function, metabolic disorders and blood coagulation function for children with mushroom poisoning, but nervous system damage that was caused by mushroom poisoning is irreversible.Although liver transplantation technology successfully cured liver failure, it still left severe neurological sequelae.

Objective:To evaluate the role of hypoxia-inducible factor-1α (HIF-1α)/Bcl-2/E1B-19kDa interacting protein 3 (BNIP3) signaling pathway in sevoflurane-induced attenuation of myocardial ischemia-reperfusion (I/R) injury in rats and the relationship with autophagy.Methods:Ninety healthy adult male Sprague-Dawley rats, weighing 300-350 g, were randomly divided into 5 groups ( n=18 each): sham operation group (Sham group), I/R group, sevoflurane group (SEV group), HIF-1a inhibitor 2ME2 group (2ME2 group), and 2ME2+ sevoflurane group (MSP group). Myocardial I/R injury model was established by ligating the left anterior descending branch of coronary artery for 40 min followed by 120-min reperfusion in anesthetized rats.In SEV group, 2.4% sevoflurane was inhaled for 15 min starting from the beginning of reperfusion.In 2ME2 group and MSP group, 2ME2 (15 mg/kg) was intraperitoneally injected at 1 h before ligation of the left anterior descending branch of coronary artery, and the other treatments were similar to those previously described in group I/R or in group SEV.Animals were sacrificed at 120 min of reperfusion, and the left ventricular myocardium was taken for determination of the expression of HIF-1α and BNIP3 (by Western blot), activity of ROS (by DHE), and myocardial infarct size (by TTC)and for observation of autophagosome (with an electron microscope). Results:Compared with Sham group, the activity of ROS, the number of autophagosome and myocardial infarct size were significantly increased in the other four groups, the expression of HIF-1α and BNIP3 was up-regulated in I/R group and SEV group ( P<0.05). Compared with I/R group, the activity of ROS, the number of autophagosome and myocardial infarct size were significantly decreased in the other four groups, the expression of HIF-1α and BNIP3 was up-regulated in SEV group, and no significant difference was found in the activity of ROS, the number of autophagosome or myocardial infarct size ( P>0.05), and the expression of HIF-1α and BNIP3 was down-regulated in 2ME2 and MSP groups ( P<0.05). Compared with SEV group, the activity of ROS, the number of autophagosome and myocardial infarct size were significantly increased, and the expression of HIF-1α and BNIP3 was down-regulated in 2ME2 and MSP groups ( P<0.05). Conclusion:HIF-1α/BNIP3 signaling pathway is involved in sevoflurane-induced attenuation of myocardial I/R injury, which is related to inhibiting autophagy in rats.

Objective To search for novel potent 3-ester derivatives of arenobufagin and test their antitumor activities in vitro. Methods Target compounds were synthesized by esterification of arenobufagin with acids. CellTiter method was used to assay the in vitro antitumor activities. Results 3-Ester derivatives exhibited excellent antitumor activities against all the cancer cells. Conclusion Among the 3-ester derivatives, compound 2a had the best activities with the IC₅₀ of 4.0−91.7 nmol/L and appeared to be a valuable candidate for further study.