BACKGROUND:The mechanism underlying orthodontic-induced external root resorption is not yet clear, and it differs individual y. Kidney deficiency has been proved to be related to bone diseases which mediated by different cytokines. Interleukin-17 is an important cytokine involved in external root resorption. So figuring out whether kidney deficiency and interleukin-17 are related to root resorption wil be helpful for etiological research.
OBJECTIVE:To explore the relationship between kidney deficiency physique, interleukin-17 and root resorption during orthodontic treatment in rats.
METHODS:Thirty-six Wistar rats were selected and equivalently randomized into two groups, fol owed by modeled into kidney deficiency (kidney deficiency group) or injected with normal saline (control group), respectively. Afterwards, the right maxil ary of each rat served as an orthodontic force model, and the left maxil ary as a non-orthodontic force model. Al rats were respectively sacrificed under general anesthesia at the 3, 7 and 14 days after given orthodontic force. Then, the mesial surface of the root of maxil ary first molars and the expression level of interleukin-17 were observed through hematoxylin-eosin staining and immunohistochemical method.
RESULTS AND CONCLUSION:Histological observation showed that significantly increasing root resorption in a time-dependent manner could be observed, and there were various absorbed lacunae of osteoclasts on the enamel in the kidney deficiency orthodontic force group. The alveolar bone resorption and widened periodontal membrane appeared in the control orthodontic force group. While no remarkable root and alveolar bone resorptions were found in the other two non-orthodontic force groups. The expression level of interleukin-17 in the kidney deficiency orthodontic force group was higher than that in the control orthodontic force group;the expression level of interleukin-17 in the kidney deficiency non-orthodontic force group was higher than that in the control non-orthodontic force group. In conclusion, kidney deficiency patients are easy to develop root resorption, the mechanism of which is maybe relevant to the upregulation of interleukin-17.

OBJECTIVE: To purify hVEGF_(121)/EGFP fusion protein using transfected BMSCs as culture media, in addition, to detect the function of hVEGF_(121)/EGFP fusion protein in vitro.METHODS: The pEGFP-N_2-hVEGF_(121) recombinant plasmid, which was constructed in the preliminary work of our study group,was used to extract the plasmid DNA. BMSCs were transfected with pEGFP-N2-hVEGF_(121) by positive ionic liposome transfection method. Under a fluorescent microscopy, the expression of hVEGF_(121)/EGFP fusion protein was detected. The hVEGF_(121)/EGFP fusion protein was purified with Am icon ultrafiltration centrifuge tube and the expression of fusion protein was detected by Western-Blotting method.RESULTS: The BMSCs, which transfected with pEGFP-N2-hVEGF_(121), was observed under the fluorescent microscope. Western blotting confirmed that pEGFP-N_2-hVEGF_(121) fusion protein expressed in the culture media of transfected BMCS. MTT results showed the number of human umbilical vein endothelial cells in the fusion protein team was significantly greater than that in the control group (P < 0.05), and Miles test confirmed that pEGFP-N_2-hVEGF_(121) fusion protein increased the permeability of the blood vessel wall.CONCLUSION: ①This study successfully confirmed the pEGFP-N_2-hVEGF_(121) recombinant plasmid, which carrying VEGF_(121)/EGFP fusion protein, can be expressed in BMSCs.②The VEGF_(121)/EGFP fusion protein have the function of wild-type VEGF in vitro.

A total of 169 patients with short-duration type 2 diabetic mellitus (DM) were divided into atherosclerosis (AS) group and non-AS group according to the intima-media thickness (IMT) of three conducting arteries.The level of serum amyloid A (SAA) was assayed by ELISA.The results showed that SAA level of type 2 DM patients increased significantly, patients in AS group showed higher SAA level than that in non-AS group, and SAA level was positively correlated with age, body mass index, waist hip ratio and IMT of common carotid artery.Age, C-reactive protein and SAA level are the major risk factors for IMT of common carotid artery.

Objective To investigate the short-term clinical efficacy of Jack vertebral dilator kyphoplasty bone grafting combined with minimally invasive fixation in the treatment of thoracolumbar fracture.Methods A retrospective case series analysis was made on 34 patients with thoracolumbar fracture treated by minimally invasive transpedicular bone grafting and fixation in the injury vertebrae with Jack vertebral dilator from December 2014 to December 2015.There were 20 males and 14 females,and their age was 25-27 years (mean,46.7 years).According to the AO classification,there were 16 cases of type A1 and 18 type A3.The injured levels were at T11 in one case,at T12 in 6,at L1 in 15,at L2 in 9 and at L3 in 3.The operation time,blood loss,fluoroscopy frequency,incision length,and postoperative hospital stay duration were recorded.The visual analogue scale (VAS),Oswestry disability index (ODI),height ratio of vertebrae,Cobb angle,and complications were evaluated at follow-up.Results The operation time was (91.2 ±9.8) minutes,blood loss was (42.4 ±4.3) ml,incision length was (7.2 ± 0.4) cm,intraoperative fluoroscopy frequency were five,postoperative hospital stay was (3.9 ± 0.5) days,and follow-up time was (13.8 ± 1.7) months.All the patients showed complete healing in the injury vertebra.The VAS was (6.4 ± 0.9) points preoperatively,(4.1 ± 0.8) points,(1.2 ± 0.4) points,and (1.2 ± 0.5) points at 7 days,3 months and 12 months postoperatively.The ODI was (39.2 ± 2.3) points preoperatively,(24.5 ± 1.9) points,(13.0 ± 3.0) points,and (12.3 ± 2.0) points at 7 days,3 months and 12 months postoperatively.At postoperative 7 days,the VAS and ODI were significantly decreased compared with those preoperatively (P ＜ 0.05) and further declined at postoperative 3 months (P ＜ 0.05),while there was no significant difference between 3 months and 12 months postoperatively (P ＞ 0.05).The height ratio of vertebrae was 47.8 ± 12.2 preoperatively,83.6 ±4.9,82.5 ±4.8,and 81.7 ±4.7 at 7 days,3 months and 12 months postoperatively.The Cobb angle was respective (22.4 ± 4.7) °preoperatively,(3.6 ± 2.4) °,(4.6 ± 2.6) °,and (5.0 ± 2.8) ° at 7 days,3 months and 12 months postoperatively.At postoperative 7 days,the height ratio of vertebrae was increased and Cobb angle was decreased significantly compared to those preoperatively (P ＜ 0.05),while there was no significant difference in the indicators at 3 days,3 months and 12 months postoperatively (P ＞ 0.05).No looseness or breakage of internal fixation was found at follow-up and all patients had fracture union at the last follow-up.Conclusion Jack vertebral dilator kyphoplasty bone grafting combined with minimally invasive fixation is safe and effective for treatment of thoracolumbar fractures,as the procedure can quickly relieve the pain,improve the function disability,effectively maintain the height of the vertebral body and restore the sagittal balance of spine.

Objective:To compare Jack dilator-kyphoplasty (DKP) and balloon-kyphoplasty (BKP) for osteoporotic vertebral compression fracture (OVCF) in postoperative vertebral height loss and adjacent intervertebral disc degeneration.Methods:A total of 94 OVCF patients were treated and fully followed up at Department of Orthopaedic Surgery, The First Hospital Affiliated to Nanjing Medical University from May 2007 to October 2016. Of them, 30 were subjected to DKP and 64 to BKP. In DKP group, there were 18 males and 12 females, with an age of (72.4±9.2) years, a bone density of (-3.99±0.88) SD and a disease course of (0.7±0.4) months; in BKP group, there were 28 males and 36 females, with an age of (71.6±14.3) years, a bone density of (-4.08±0.63) SD and a disease course of (0.6±0.3) months. The 2 groups were compared in terms of change in the height of injured vertebrae, disc height index percentage (DHIP) and Pfirrmann grading of adjacent disc degeneration at preoperation, 2 days and 36 months after operation.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). The anterior and middle heights of injured vertebrae and DHIP at postoperative 36 months were significantly lower than those at postoperative 2 days in both groups ( P<0.05). There was no significant difference between the 2 groups in DHIP at 36 months after operation (79.86%±4.48% versus 80.24%±6.85%) ( t=0.277, P=0.782). By the Pfirrmann grading, 36 and 84 patients had intervertebral disc degeneration in DKP and BKP groups respectively. There was no significant difference in the incidence of intervertebral disc degeneration between the 2 groups (60.0% versus 65.6%) (χ 2=0.560, P=0.454). Conclusions:In the OVCF treatment, DKP and BKP may potentially cause height loss of the injured vertebrae and degeneration of adjacent intervertebral disc, but no difference was found in disc degeneration between the 2 modes.

Objective To explore the prevalence and epidemic characteristics of overweight, obesity, and central obesity in Shanghai Pudong New Area. Methods Multi-stage stratified random sampling method was conducted in Pudong New Area in 2013. Residents over 15 years old were randomly selected from 13 communities and participated in the cross-sectional study. A structured questionnaire was used to collect the information and physical examination, biochemical assays were also conducted. SPSS 20. 0 was used to analyze the results. Results The averagebodymassindexofparticipantswas(25.04±3.79)kg/m2andtheaveragewaistcircumferencewas(82.44± 9. 51) cm. The prevalences of overweight, obesity, and central obesity were 41. 67%, 17. 70%, and 31. 32%respectively. Standardized prevalences of overweight, obesity, and central obesity were 34. 39%, 16. 96%, and 25. 66% respectively, according to 2010 national age composition of population. Statistically significant sex differences were found among the prevalence of overweight, obesity, and central obesity groups(all P<0. 05). The prevalence of central obesity in female was raised by increasing age. Residents with hypertension, hyperglycemia, dyslipidemia, and metabolic disorders had higher prevalences in overweight, obesity, and central obesity ( all P<0. 05). Conclusion The prevalences of overweight, obesity, and central obesity among the residents in Shanghai Pudong New Area were relatively high. Relevant risk factors should be explored to promote health education that may enhance people′s awareness of weight management.

Objective:To evaluate the accuracy and safety of cervical pedicle screw (CPS) placement under orthopaedic robot navigation system guidance.Methods:From March 2019 to February 2021, the data of 33 patients (19 males and 14 females, aged from 26 to 75 years, with an average age of 50.5 years) treated with pedicle screw fixation with the assistance of orthopaedic surgery robot through the posterior cervical spine were retrospectively analyzed. In clinical diagnosis, there was upper cervical fracture with instability in 14 patients (fracture nonunion in 2 patients), upper & subaxial cervical fracture in 1 patient, cervical spinal cord injury with spinal stenosis in 2 patients, cervical spinal stenosis in 9 patients, occipitocervical deformity in 2 patients, post-operative revision of cervical spondylosis in 2 patients, cervical intraspinal tumor in 3 patients. A total of 151 CPSs were inserted in C 1-C 7 using robot navigation system based on intraoperative three-dimensional C-arm fluoroscopy to assist in screw placement in posterior cervical surgery. Among them, 74 screws were implanted into upper cervical spine; 77 screws were implanted in the lower cervical spine. CT was used to obtain image data within 7 days after operation, and Neo classification was used to evaluate the accuracy of cervical pedicle screw placement. The patients were followed up for 2 weeks to observe the clinical symptoms and signs, and to determine whether there were surgical complications such as nerve and blood vessel injury and incision infection. Results:According to Neo classification, 91.4% (138/151) screws were completely contained in the pedicle without breaking through the pedicle cortex (grade 0). Among them, the accuracy of C 1 screws was 97.1% (34/35), C 2 screws was 92.3% (36/39), C 3 screws was 88.2% (15/17), C 4 screws was 71.4% (10/14), C 5 screws was 85.7% (12/14), C 6 screws was 93.3% (14/15), C 7 screws was 100.0% (17/17). The screw accuracy was highest in C 7, the lowest in C 4. The Kruskal-Wallis H test was performed on the accuracy of screw placement in different cervical level, and the results showed that there was no statistical difference (χ 2=1.31, P=0.971). However, a total of 13 screws were found to perforate the cortex of pedicle, although any neural or vascular complications associated with CPS placement were not encountered. Among them, 9 screws were found to perforate laterally, and 4 screws were found to perforate medially. No postoperative incision infection occurred in all cases. Conclusion:The safety of CPS placement can be effectively guaranteed with the assistance of the orthopaedic robot system.

Objective:To compare the clinical efficacy of robotic-assisted and fluoroscopy-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).Methods:A total of 27 patients with lumbar degenerative disease receiving robot-assisted MIS-TLIF (robot-assisted group) treatment in the First Affiliated Hospital of Nanjing Medical University from May 2020 to September 2021 were retrospectively analyzed, including 9 males and 18 females, aged 61.00±9.11 years (range, 41-71 years). Twenty-seven patients who received fluoroscopic-assisted MIS-TLIF (fluoroscopic-assisted group) during the same period were selected as controls, including 16 males and 11 females, aged 56.70±11.97 years (range, 32-76 years). Operation time, intraoperative bleeding, radiation exposure time, postoperative drainage, hospitalization time, visual analogue scale (VAS) for pain, Oswestry disability index (ODI), accuracy of pedicle screw placement, and postoperative complications were recorded. The learning curve of the robot-assisted group was drawn based on the amount of surgery and the operation time by fitting the logarithmic curve.Results:All patients successfully completed the operation and were followed up for 15.44±3.89 months (range, 12-24 months). The operation time, drainage volume, and hospitalization time in the robot-assisted group were 181.44±36.43 min, 43.70±22.04 ml, and 5.04±1.40 d, respectively, which were smaller than 223.22±59.40 min, 74.63±71.86 ml, 6.59±3.04 d in the fluoroscopy-assisted group, and the differences were statistically significant ( P<0.05). The radiation exposure time in robot-assisted group was 77.78±9.81 s, which was larger than fluoroscopy-assisted group (63.78±17.70 s). There were statistically significant differences in lumbar VAS scores between the two groups before and after surgery ( P<0.05), 3 days after operation and the last follow-up was smaller than those before operation. The VAS score on postoperative day 3 in the robot-assisted group was 2.52±0.98, which was less than 3.07±0.87 in the fluoroscopically-assisted group ( t=0.294, P=0.032). In both groups, 108 pedicle screws were placed, and the accuracy of nail placement in the robot-assisted group was 93.5% (101/108), which was greater than that in the fluoroscopically-assisted group 77.8% (84/108), and the difference was statistically significant (χ 2=11.821, P=0.008). By fitting a logarithmic curve to describe the relationship between the number of operations and the operation time of the robotic-assisted group of operators, the results showed that the operation time decreased with the increase of the number of operations, and the operation time fluctuated greatly in the first 10 cases, and then gradually shortened and stabilized after 10 operations. Conclusion:Robot-assisted MIS-TLIF can improve the accuracy of pedicle screw placement, improve the early postoperative pain and shorten the learning curve.

Objective:To understand the epidemiological characteristics of infectious diarrhea pathogens in Pudong New Areas of Shanghai from 2013 to 2017 to provide evidence for control and prevention of the disease.Methods:From Jan 2013 to Dec 2017, active surveillance program on diarrhea was conducted in 14 sentinel hospitals (three tertiary-level and nine secondary-level, and two primary-level hospitals) in Pudong New Areas of Shanghai, based on location, catchment areas and number of patients. All recruited outpatients were interviewed in hospitals, using a standard questionnaire. Stool specimens were collected and tested for five viral and eight bacterial pathogens.Results:A total of 9 301 cases with infectious diarrhea were included, and the overall positive rate was 55.7 % (5 179). Positive rates of single virus, single bacteria and mixed infections were 26.7 % (2 481), 17.0 % (1 579) and 12.0 % (1 119), respectively. For single infection, the most commonly detected viruses appeared as norovirus (15.4 %, 1 428/9 301) and rotavirus (7.2 %, 667/9 301). The most commonly detected bacteria were diarrheagenic Escherichia coli (6.7 %, 619/9 301) and non-typhoid Salmonella (3.3 %, 305/9 301). The most common mixed infections were caused by virus-bacteria (4.9 %, 459/9 301). Norovirus (17.0 %, 838/4 938) showed the highest positive rates, followed by Escherichia coli (7.2 %, 354/4 938), both seen in the age group of 20-59 years old group. Rotavirus (9.4 %, 178/1 896) and non-typhoid Salmonella (4.9 %, 93/1 896) were the most common pathogens found in the age group of 0-4 years old. The prevalence of norovirus peaked both in spring and autumn. The other peaks were seen as: Rotavirus in winter, diarrheagenic Escherichia coli in summer and non-typhoid Salmonella in summer. Conclusions:Our data showed that the positive rates of infectious diarrhea pathogens were high in Pudong New Areas of Shanghai from 2013 to 2017. The dominant pathogens would include norovirus, rotavirus and diarrheagenic Escherichia coli but with differenct distributions in age groups. Obvious seasonal patterns were also observed.

Objective:To evaluate the impact of orthopedic robotic assistance and conventional freehand methods on surgical strategies, the safety of pedicle screw placement, and clinical efficacy in patients with upper cervical spine diseases.Methods:From January 2017 to March 2023, a total of 63 cases with upper cervical spine disease, were divided into two groups based on the screw placement technique: the robot-assisted pedicle screw placement (RA) group (41 cases) and the conventional freehand pedicle screw placement (CF) group (22 cases), were retrospectively included. These patients in the RA and CF groups underwent two types of posterior cervical surgery, including occipitocervical fusion (9 cases and 8 cases) and fixation and fusion of atlantoaxial and distal vertebrae (32 cases and 14 cases). The outcome parameters, including the disease course, surgical time, intraoperative blood loss, fluoroscopy frequency, radiation dose, hospital stay, treatment costs, complications, the rate of the pedicle screw placement, accuracy of upper cervical pedicle screw placement, and the risk factors that possibly affected the accuracy were recorded and analyzed. Postoperative follow-up was conducted for at least 6 months, and the efficacy of patients was assessed using imaging parameters, ASIS classification, VAS, and JOA scores.Results:Both groups had no screw-related complications and no spinal cord or vertebral artery injuries. In the RA group, the pedicle screw placement rates for the patients with occipitocervical fusion, and fixation and fusion of atlantoaxial and distal vertebrae were 100% (48/48) and 89.6% (138/154), respectively, far exceeding the placement rate in the CF group 42.9% (18/42) and 78.3% (54/69) (χ 2=37.403, P<0.001; χ 2=5.128, P=0.024). The fluoroscopic exposure dose and operation time of the two types of surgical patients in the RA group were both higher than those in the CF group ( P<0.05). Compared with the CF group, the accuracy of C 1 screws in the RA group increased from 42% (11/26) to 80% (51/64), with statistical significance (χ 2=13.342, P=0.004); while the accuracy of C 2 screws improved from 77% (33/43) to 88% (63/72) with no statistical difference (χ 2=2.863, P=0.413). Non-parametric correlation analysis found a significant correlation between the accuracy of C 1 and C 2 pedicle screw placement and the order of guide wire insertion in the RA group ( r=0.580, P<0.001; r=0.369, P=0.001). Postoperatively, both groups showed significant differences in cervicomedullary angle (CMA), Chamberlain angle (CL), McGregor angle, Boogard angle, Bull angle, clivus-canal angle (CCA), occipitocervical (C 0-C 2) angle, posterior occipitocervical angle (POCA), C 2-C 7 angle, and anterior atlantodental interval (ADI) ( P<0.05). The ASIA classification improved to varying degrees for both groups postoperatively, but there were no statistically significant differences between preoperative, postoperative, and last follow-up evaluations. VAS and JOA scores significantly improved for both groups postoperatively and at the last follow-up ( P<0.05). Conclusion:Both orthopedic robotic-assisted and conventional freehand pedicle screw placement techniques achieved satisfactory therapeutic effects in the treatment of upper cervical spine diseases. The orthopedic robot can effectively ensure the accuracy of upper cervical pedicle screw placement, the increase placement rate of pedicle screws in the upper cervical spine, and reduce fluoroscopy exposure. However, it is necessary to avoid the vertebral displacement caused by the priority insertion of the guide needle, which may affect the accuracy of subsequent planning.