Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD),and to explore the indications and crucial techniques of posterior approach.Methods All of 17 Consecutive patients (8 males and 9 females) with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study,the mean age was 35.2±13.8 years with a range of 12-56 years.The clinical symptoms and signs was recorded,and preoperative imaging examination,including anteroposterior,lateral,dynamic films,MRI and CT of cervical spine,were performed to identify the series.There were 14 cases with atlanto-occipital fusion,7 cases with C2,3 fusion,6 cases with Chiari malformation,6 cases with Syringomyelia,and 8 cases with myelomalacia.The clinic symptoms include occiput/neck pain in 15 cases,cervical movement limitation in 13 cases,short neck in 9 cases,torticollis in 12 cases,Paresthesia in 14 cases,weakness in 13 cases,tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases.The postoperative X-rays,MRI or CT were used to observed the results of decompression,fixation and fusion.Neurological function was assessed by JOA scale and Ranawat's score before,after surgery and at final follow-up.Pre-and post-operative Chamberlain (CL),Wackenheim (WL),McGae (ML),atlantodental interval (ADI) and cervico-medullary angle (CMA) were analyzed by student t-test.Results The average operation time was 145 mins (90-210 mins) and blood loss was 175 ml (150-350 ml).The average follow-up was 44.47 months (9-94 months).JOA score was increased from 8.06 preoperatively to 15.20 postoperatively,the improvement rate was 77.2％.Preoperative Ranawat's score was Ⅱ in 1 case,Ⅲla in 12 cases,ⅢB in4 cases.Postoperative score was Ⅰ in 13 cases,Ⅱ in 4 cases.The preoperative CL,WL,ML,ADI and CMA were (12.52±5.17) mm,(6.59±3.04) mm,(6.96±4.32) mm,(9.88± 1.93) mm,115.35°± 12.40°,respectively.and the postoperative CL,WL,ML,ADI and CMA were (2.0±3.67) mm,(-3.06±1.85) mm,(-1.76±2.88) mm,(1.17± 1.18) mm,136.76°±11.44°,respectively.The perioperative complications were discovered in 2 cases,including 1 case of infection and1 case of cerebrospinal fluid(CSF) leakage.Conclusion Primary surgery of nerve release and bone reduction by posterior approach may be safe and efficient for the treatment of BI and IAAD.Preoperative evaluation,proper surgical indications and advanced surgical techniques are important for treatment results.

OBJECTIVETo investigate the application of relay flaps pedicled by perforator from digital artery for reconstruction of soft tissue defects at finger tip.

METHODSFrom Mar. 2012 to Jun. 2014, 9 cases with soft tissue defects at finger tip were reconstructed with relay flaps at one side of finger pedicled by perforator from digital artery. The flap size ranged from 1.3 cm x 1.6 cm to 1.6 cm x 2.2 cm. The defects at donor sites were covered by adjacent web perforator V-Y advanced flaps.

RESULTSAll the 18 flaps in 9 cases survived completely with primary healing both in recipient and donor sites. The patients were followed up for 5 months to 2 years ( average, 12 months) with good elasticity and cosmetic results. No pain happened in the treated finger. The 2-point discrimination distance was 7-8 mm in fingertip flaps, and 10-12 mm in web perforator flaps. Hand function was graded as excellent in 7 cases, good in 2 cases, based on ATM assessment. The affected fingers had normal temperature and cold-resistance during winter. The width and depth of web in the donor site were not affected.

CONCLUSIONSThe relay flaps pedicled by perforator from digital artery can be applied for reconstruction of soft tissue defects at finger tip. The procedure is easy with satisfactory results and reservation of main artery. No skin graft is necessary for closure of defects on donor sites.

Arteries ; Elasticity ; Finger Injuries ; surgery ; Fingers ; blood supply ; Follow-Up Studies ; Humans ; Perforator Flap ; transplantation ; Time Factors ; Transplant Donor Site ; Wound Healing

BACKGROUND:Until now, there is yet no complete recovery from spinal cord injury in terms of structure and functional recoveries. Neurotrophic factors have limited effects on nerve regeneration. Currently, stem cel transplantation may be an effective way to repair spinal cord injury.
OBJECTIVE:To separate, cultivate and purify mouse spinal cord-derived neural stem cels using serum-free suspension method folowed by morphological observation, immunofluorescence technology and multi-lineage differentiation experiments.
METHODS:By using the suspension culture method, mouse spinal cord-derived neural stem cels at embryonic day 13.5 were cultured and purified. Cel morphology changes were observed under inverted microscope. Cel proliferation ability was detected using cel counting kit-8. Nestin and Sox2 expression was detected by immunofluorescence technology. Multilineage differentiation of spinal cord-derived neural stem cels at passage 4 was detected by natural differentiation method in order to prove the differentiation ability.
RESULTS AND CONCLUSION: Serum-free medium suspension culture method was successfuly applied to separate spinal cord-derived neural stem cels. Cultured cels had good proliferative ability and highly expressed Nestin and Sox2 that was in accordance with the results of DAPI nucleus staining, suggesting the high purity of cels. After induction, the cels could express both Tuj1 and GFAP, indicating the cels had good differentiation potential. This experiment has successfuly established the isolation, culture, identification system of spinal cord-derived neural stem cels, providing experimental basis for subsequent studies of neural stem cels.

BACKGROUND:Currently, bone graft is mainly used for repair of bone defects, and tricalcium phosphate is the most used artificial bone material. But the effectiveness of the tricalcium phosphate bone graft is stil controversial, and there is also no detailed report about its function during the healing of bone defect. ＜br> OBJECTIVE:To observe the concentration changes of bone morphogenetic protein-2 and vascular endothelial growth factor as wel as bone healing after tricalcium phosphate graft in bone defects. ＜br> METHODS:Forty-eight C57 mice were randomly divided to experimental group and control group. A 2-mm-long diaphyseal segment and periosteum from the middle of the right femur was cut to prepare unilateral bone defect models. Tricalcium phosphate bone graft was used in the experimental group, and no bone graft in the control group. During the fol owing 4 weeks, X-ray examination was done once a week to observe the bone healing, and then the animals were executed for col ecting samples in the graft area. The concentrations of bone morphogenetic protein-2 and vascular endothelial growth factor in samples which were taken from the bone graft area were determined by using ELISA assay. ＜br> RESULTS AND CONCLUSION:X-ray films showed that 2 weeks later, bone fracture healed mostly in the experimental group except a smal part of cortical bone;3 weeks later, bone fracture was basical y healed, and only a smal amount of tricalcium phosphate remained;4 weeks later, bone fracture was completely healed, and the cal us grew obviously, and the tricalcium phosphate was nearly absorbed. In the control group, the fracture line was stil visible at 1-2 weeks, but it became vague at 3 weeks;then, the fracture was healed at 4 weeks except some of the cortical bone. The levels of bone morphogenetic protein-2 and vascular endothelial growth factor were significantly higher in the experimental group than in the control group at different time points (P＜0.05). These results suggest that tricalcium phosphate bone graft can up-regulate the expression of bone morphogenetic protein-2 and vascular endothelial growth factor and accelerate bone healing.

AIM: To compare the clinical results of suture method and partial eyelash resection treating for pediatric eyelid trichiasis, and screen an effective method for the treatment of pediatric lower eyelid trichiasis.
METHODS: Fifty-six cases of pediatric patients with lower eyelid trichiasis were randomly divided into a control group and an observation group in accordance with the method of drawing lots, and each group was 28 cases. The control group was treated with suture method, and the observation group was treated with partial eyelash resection. The clinical efficacy, patient satisfaction before and after treatment, and the incidence of complications were compared.
RESULTS:(1) The clinically total effective rate was 74%of the control group, which was 89% of the observation group, and there were statistical differences of the clinical efficacy between the two groups ( P<0. 05 ); ( 2 ) the satisfaction scores were (3. 89±1. 22) points and (6. 27±1-86) points of the the control group before and after treatment, which were ( 4. 00±1. 34 ) points and ( 8-95±2-34) points of the observation group, and there were statistical differences of the two groups before and after treatment (P<0. 05), and the scores of the observation group were higher than that of the control group ( P<0-05);(3) complications such as swelling and stitches off appeared in both groups, and the rate was 21% in the control group, which was 11% in the observation group, and there were statistical differences between the two groups (P<0. 05).
CONCLUSION: The treatment of children with lower eyelid trichiasis, suture method is simple and can be performed under local anesthesia in collaboration with children, but with a higher relapse rate, some patients required reoperation;partial resection of eyelashes can be more thoroughly solve the problem of pediatric eyelid trichiasis with low recurrence rate, but children need to be under general anesthesia with some of big risk. So partial resection of eyelashes is unsuitable for using in clinical practice widely and can be used in special cases.

Neuroligins (NLs) are postsynaptic membrane proteins expressed in the brain and mediate synaptogenesis. Neuroligin family proteins can specifically induce either excitatory or inhibitory synapses. Deletions or point mutations in neuroligin genes are found in patients with autism spectrum disorders (ASD) or mental retardations. The dysfunctions of these mutations have been tested in multiple neuroligin mouse models. In most of the models, including the human autism-linked NL3 and NL4 mutation mice, there are social interaction defects, memory impairment and repetitive behaviors. Researchers also found the excitatory/inhibitory synapse ratio altered in those mice, as well as receptor subunit composition. However, inconsistencies and debates also exist between different research approaches. In this review, we summarize the neuroligin mouse models currently available, examine the detailed alterations detected in those mice and compare the differences within different mouse models or different investigation methods, to obtain an overall picture of the current progress on neuroligin mouse models.
Animals ; Autistic Disorder ; physiopathology ; Brain ; physiopathology ; Cell Adhesion Molecules, Neuronal ; physiology ; Disease Models, Animal ; Humans ; Membrane Proteins ; physiology ; Mice ; Mutation ; Nerve Tissue Proteins ; physiology ; Synapses ; physiology

Objective To explore the expressions of apoptosis gene Bcl-2 (B-cell leukemia-2) and Bad (bcl-xl/bcl-2-associated death promoter) in lung tissue of mice with acute lung injury (ALI). Method Twenty-four BALB/C female mice were randomly divided into control saline group (n = 6) and ALI group (n = 18). The ALI Group was further divided into 3 subgroups with 6 mice in each subgroup: ALI (4 h) ,ALI (6h) ,and ALI (8h) subgroups. Rats in the normal control group received injection of saline. The ALI models were produced by in-jection of oleic acid (0.9 mL/kg) via vena caudalis, and the criteria were met with the characteristically pathologi-cal changes in the lung tissue. Pathological changes of the lung tissue were examined and scored under light mi-croscopy 4 h,6 h and 8 hours after injury. The expressions of gene Bcl-2 and gene Bad were detected in lung tissue at above set intervals by using RT-PCR. Data of these assays were analyzed by using one-way ANOVA with SPSS version 13.0 software. Statistical significance was established at a P value of less than 0.05. Results The rela-tive magnitude of Bel-2 expression in ALI (4 h), ALI (6 h) and ALI (8 h) subgroups were significantly higher (58.00±5.31), (42.00±4.30), (32.51±10.40) as compared with the control group (24.30±1.00) (F =68.581, P < 0.05). The relative magnitude of Bad expressions in ALI (4 h), ALI(6 h) and ALI (8 h) sub-groups were signiticantly higher (29.32±1.19), (58.64±4.45), (95.12±4.34)as compared with control group (4.01±0.34) (F = 386.902,P < 0.05). The pathological scores ofhmg injury in ALI(4h), ALI (6 h) and ALI (8 h) subgroups were significantly higher (1.82±0.14), (2.52±0.25), (3.45±0.29) as compared with control group (0.27±0.03) (F = 260. 512, P <0.05). Comparisons between groups showed statistical signifi-cances (P < 0.05). Conclusions The aggravation of lung injury induced by oleic acid in mice related to the down-regulation of apoptosis gene Bcl-2 expression and up-regulating apoptosis gene Bad expression in lung tissue.

Objective To evaluate the efficacy of mobile endospine system for sequested lumbar disc herniation.Methods From May 2007 to December 2009,31 patients of sequested lumbar disc herniation were treated with mobile endospine system,including 17 men and 14 women with a mean age of 46 years (32-59 years).Patients complained severe leg and low back pain with disability.According to MRI,the sequested nucleus herniated from the disc of L2-3 in 1 case,L3-4 in 1,L4-5 in 16 and L5S1 in 13;and the direction of herniation was caudal in 24 cases,cephalic in 6 and indistinguishable in 1.The patients were followed up for 12 months (range,6-24 months) ,and the results were evaluated according to Macnab scale.Results The procedure was technically successful in all the patients:the sequested nucleus was completely extracted.The protruded disc was treated with discectomy in 30 cases,and the nearly intact disc was left untouched in one patient.Among the 24 cases with caudal herniation,sequested nucleus situated ventrally beneath the dural theca and the transitional nerve root in 15 cases,between the nerve root and dural theca in 5,and dorsally on the nerve root and dural theca in 4.All the 6 cephalic herniation situated beneath the dural theca,1 of them reached the level of pedicle,and 2 herniated into the intervertebral canal.The sequested disc presented as indistinguishable signal on MRI included nucleus,annulus and cartilage endplate,and situated dorsally around the dural theca.The mean operative time was 50 min (range,40-70 min) with a mean blood loss of 80 ml (range,30-200 ml).There was no complication of nerve injury.Only too much facet was resected in 2 patients without clinical symptom.The results were excellent in 21 cases and good in 10 cases,and all of them were satisfied with this procedure.Conclusion The working canal and visual field of mobile endospine system is movable,so the sequested nucleus can be extracted completely with good results.

Objective To investigate the relationship between extracellular matrix metalloproteinase inducer (EMMPRIN), the upstream regulatory factor of matrix metalloproteinase (MMPs), and the formation of atherosclerosis and the clinical type of coronary heart disease. Methods A total of 223 patients were classified into four groups according to results of coronary angiography (CAG) and clinical data: STEMI group (65 patients with ST-segment elevation myocardial infarction), NSTE ACS group (42 patients with non-ST-segment elevation acute coronary syndrome), SAP group (75 patients with stable angina pectoris) and normal control group (41 patients of CAG-negative). The mean fluorescence intensity (MFI) of EMMPRIN on monocytes of peripheral blood (PBMCs)were examined by flow cytometry. MMP-9 in serum was measured with ELISA; high-sensitivity C-reactive protein (hs-CRP) in serum was measured with immune velocity method. Results The EMMPRIN MFI on PBMCs in SAP group, STEMI group and NSTE ACS group was higher than that in the normal control group (P<0.05 or P<0.01). The EMMPRIN MFI in STEMI group and NSTE ACS group was higher than that in SAP group (P<0.05 or P<0.01). The expression characteristic of EMMPRIN on the PBMCs was consistent with that of hs-CRP and MMP-9 in each group. The EMMPRIN MFI of the PBMCs had positive correlation with the level of MMP-9 and hs-CRP in serum (r=0.168,P<0.05;r=0.305,P<0.01). Conclusion EMMPRIN may has promotive effect on the formation of atherosclerosis and unstablility of coronary heart disease as an upstream regulatory factor of MMPs

Objective To observe the clinical effect of percutaneous endovascular angioplasty ( PTA) for the treatment of diabetic lower extremity arterial disease( LEAD) , so as to provide a reference for the selection of the best treatment for diabetic lower extremity arterial dis-ease(LEAD). Methods In this parallel study, totally 60 patients were equally divided into the control group and the intervention group. The control group were treated by the conventional method, and the intervention group were treated by percutaneous endovascular angioplasty (PTA). The changes of ankle brachial index (ABI),average blood flow velocity of dorsalis pedis,pulsation index(PI) and the maximum walking distance were observated in 12 weeks and 24 weeks after the treatment. Results Compared with the control group, the ankle brachi-al index ( ABI) , average blood flow velocity of dorsalis pedis, pulsation index ( PI) and the maximum walking distance in the intervention group were significantly improved 12 weeks and 24 weeks after treatment, and the difference between the two groups was statistically signifi-cant (P<0. 05). And compared with thses data before treatment in the intra-group comparison, there were statistically significant difference (P<0. 05). However, the changes in 24 weeks and 12 weeks after treatment in the same group showed no significant difference (P>0. 05). Conclusion Percutaneous endovascular angioplasty ( PTA) is better than traditional drug therapy in the treatment of diabetic lower extremity arterial disease( LEAD) . It is a feasible clinical treatment of lower extremity arterial disease( LEAD) .