BACKGROUND:Recently, non-fusion technology representing as artificial cervical disc replacement continues to improve. On the basis of reconstruction of disc structure and function of involved segments, cervical spine structure of surgery area segment is significantly close to dynamic and static load stress distribution required by natural physiological systems. It effects are apparent in protecting intervertebral facet joints of degenerated segment and structure and function of the cervical spine of adjacent segments and in maintaining cervical dynamic stability, which presented obvious methodological strengths compared with segmental fusion technology.
OBJECTIVE:To evaluate the clinical outcomes of anterior cervical discectomy and fusion and Bryan artificial cervical disc replacement in the treatment of single-level cervical spondylotic myelopathy or radiculopathy.
METHODS:A total of 43 middle and old age patients with single-level cervical spondylotic myelopathy or radiculopathy, who were treated from March 2010 to March 2012, were enrol ed in this study. They were randomly assigned to anterior cervical discectomy and fusion group (fusion group) and Bryan artificial cervical disc replacement group. Range-of-motion of cervical overal and adjacent intervertebral area near the intervertebral space was observed with radiography. During fol ow-up, postoperative recovery of neurological function was evaluated using Japanese Orthopaedic Association scale, visual analog scale and neck disability index.
RESULTS AND CONCLUSION:None patients experienced complications of neurovascular injury during and after the surgery. Range-of-motion of postoperative overal cervical vertebra and adjacent joint was improved in the Bryan artificial cervical disc replacement group compared with the fusion group. Neurological function was apparently improved after surgery in each group. At 3 months after surgery, scores of Japanese Orthopaedic Association, visual analog scale and neck disability index were significantly improved in the Bryan artificial cervical disc replacement group compared with the fusion group (P<0.05). During final fol ow-up, there were significant differences in visual analog scale scores between the two groups. Japanese Orthopaedic Association scale score and neck disability index score were similar between the two groups. During fol ow-up, no prosthesis sinking, displacement or heterotopic ossification were detected. These data indicated that artificial cervical disc replacement could effectively keep the range of motion of cervical segments and protect disc degeneration of adjacent segment. Mid-term fol ow up obtained similar improvement of neurological function of fusion surgery. The moderate-term and short-term efficacies of non-fusion technology were better than fusion technology in the treatment of single-level cervical spondylopathy.

ObjectiveTo assess the diagnosis and treatment of staphylococcal scalded skin syndrome (SSSS)in children.MethodsA total of 177 children whh SSSS were eligible for this study.Clinical data were retrospectively reviewed to assess the patients' age and geographical areas,predisposing factors,prodrome,clinical features,results of laboratory examination(including bacterial isolation and drug susceptibility test),treatment and prognosis.ResultsThe median age at onset was 23 days past 15 months.Infants aged 1 to 3 years were the most commonly affected population.The male to female ratio was 8:9.SSSS occurred in summer or autumn in 71.2％ of the patients.Most patients came from countryside.Of these patients,148 (83.6％) had no definite inducement,13 (7.3％) had fever or cold history before the occurrence of SSSS.Skin lesions often began in the face(71.6％).Almost all cases presented with erythema and blisters.Abnormal myocardial enzymes were observed in 104(80.6％) of 129 patients,and Staphylococcus aureus was isolated from 38.7％ of 142 patients.Susceptibility testing of 21 Staphylococcus aureus isolates from patients in the past 3 years showed that 95.2％ and 95.0％ were sensitive to cephalosporins and amoxicillin/clavulanic acid respectively.Double-antibiotic therapy was effective in 72.9％ of the patients.Intravenous gamma globulin was given to 36.2％ of the patients in the early stage.Myocardial-protecting drugs were also administrated early in patients with abnormal myocardial enzymes.All the patients healed without scarring.ConclusionsFor infants with acute facial erythema and exfoliative skin lesions,SSSS should be suspected and timely antibiotic treatment should be given.Cephalosporins and semi-synthetic penicillins are effective and the first choice for the treatment of SSSS.Meanwhile,early addition of gamma globulin and myocardial-protecting drugs may be beneficial to disease recovery.

Objective:To investigate the regulatory effects and mechanism of mannose-binding lectin(MBL) on autophagy during the differentiation of 3T3-L1 adipocytes, and provide the feasibility for targeting autophagy to prevent obesity and related pathological conditions in natural immunity.Methods:3T3-L1 preadipocytes were cultured in vitro and induced to differentiation. Cell differentiation and lipid accumulation were analyzed by oil red O staining and CCK-8 was used to detect the effect of different concentrations of MBL (0, 1, 5, 10 μg/ml) on cell proliferation ability at different differentiation stages. Western blot was used to analyze the expression of MBL(10 μg/ml) on the key autophagy factors LC3B, Beclin1 and p62 protein at different stages of differentiation, and the changes of lipid droplet accumulation under the intervention of MBL were observed by oil red O staining. The protein and mRNA expression of autophagy key factors under the intervention of different concentrations of MBL were detected by Western blot and qRT-PCR. And autophagy flow analysis based on autophagic degradation was used to further illustrate the autophagic activity. The expression and phosphorylation of adenosine monophosphate-activated protein kinase(AMPK)/mammalian target of rapamycin(mTOR) signaling molecules were analyzed by Western blot. Results:The results of oil red O staining showed that 3T3-L1 preadipocytes could achieve complete differentiation after 10 days of induction. CCK-8 showed that the concentration of MBL (1-10 μg/ml) in the experimental group had no effect on cell proliferation at different differentiation stages. During the differentiation of 3T3-L1 preadipocytes, Western blot and qRT-PCR showed that the expression of autophagy-related proteins and mRNA levels was enhanced in the MBL treated group, and presented a concentration-dependent relationship. Oil red O staining showed that the lipid droplets in adipocytes at different stages of differentiation are reduced to varying degrees under the intervention of MBL. Fluorescence microscopy results further confirmed that MBL enhanced the autophagy activity of adipocytes by increasing the synthesis of autophagosomes. Moreover, under the intervention of MBL, the phosphorylation level of AMPK was significantly up-regulated, while the phosphorylation level of mTOR was significantly down-regulated, also showing a concentration-dependent relationship.Conclusions:MBL accelerates the autophagy process during the differentiation of 3T3-L1 adipocytes through AMPK/mTOR signaling pathway, reduces lipid accumulation, providing a possible functional pathway for the treatment of obesity and related metabolic diseases.

OBJECTIVE:To establish the method for the determination of doxofylline in human serum. METHODS:Online two-dimensional column switching-HPLC was adopted to determine the concentration of doxofylline in human serum. First-dimensional chromatographic column was Waters C18column,and middle column was SC2. First-dimensional and second-dimensional column mobile phrase were methanol-water(70 : 30,V/V). The detection wavelength was 273 nm,and column temperature was 40 ℃. Sample volume was 10 μL. RESULTS:The linear range of doxofylline were 0.5-50.00 μg/mL(r=0.999 9), and the detection limit was 0.01 μg/mL. The quantitative limit was 0.5 μg/mL. RSDs of intra-day and inter-day were 1.51%-1.89%and 1.52%-1.92%(n=5). The accuracy were 97.91%-104.19%(n=5). Extraction recoveries rate were 91.63%-93.44%(RSD<2.00%,n=3). RSD of matrix effect were lower than or equal to 3.01%(n=6),and RSD of stability test was lower than 5.00%(n=6). After 3 patients were given intravenous injection of Doxofylline and glucose injection(0.3 g/d)up to steady state,the serum concentrations of doxofylline were 3.23,3.35,3.68 μg/mL before medication on the next day(RSD=2.28%,2.34%, 2.14%,n=5). CONCLUSIONS:The method is simple,rapid,accurate and suitable for the determination of plasma concentration of doxofylline.

Objective:To evaluate the diagnosis, surgical treatment, and neurological function recovery after surgery of patients with intraspinal tumors. Methods:The clinical data of 69 patients who suffered from intraspinal tumors and underwent surgery from Janu-ary 2008 to December 2012 were retrospectively analyzed. Neuroimaging and ASIA scoring were performed to examine the pathologi-cal characteristics of tumors and the neurological function of these patients before and after treatment. The major factors affecting prognosis were also probed, and the average follow-up period was 12.2 months. Results:Of the total cases, 62.3%showed intradural extramedullary intraspinal tumors located in the thoracic vertebra. Neurilemoma (Schwannoma) and meningioma were the most com-mon pathological types (53.5%). Posterior approaches with hemi-and complete-laminectomy were conducted to expose the intraspi-nal tumors, and the separation and removal of the tumors located at the cervical and thoracic levels were aided with surgical microsco-py. The main clinical symptoms, including back pain, radicular neuralgia, sensory disturbance, and motor dysfunction, were significant-ly improved after surgery, and this observation was supported by the follow-up ASIA scores before and after treatment. Of the in-volved cases, 91%were successfully treated, and their tumors were totally resected. Conclusion:Total or subtotal intraspinal tumor re-section enhanced with surgical microscopy could achieve satisfactory clinical results through posterior hemi-or complete-laminectomy.

Objective In vitro model with three dimensional cell culture provides the appealing biomimetic platform to probe the biological characteristics of multiple stem cells,which serves as an important in vitro tools to investigate regulating factors controlling the proliferation and differentiation of neural stem cells (NSCs).The present study aims to reconstruct an integrated poly-peptide hydrogel made extracellular matrix (ECM) enhanced with cyclo-RGD molecular [c(RGDfK)] for the exploration of NSCs bio-characteristics.Methods Spinal cords from one-d-old SD rats were collected and spinal-derived NSCs were induced in the complete medium; immunofluorescence staining was employed to observe the NSCs morphology and identify NSCs.Three hydrogel including type Ⅰ collagen,self-assembly poly-peptide nanofiber hydrogel (SAPNH) of RADA16 and RADA16-c(RGDfK) were employed to serve as culturing ECM of spinal-derived NSCs to mimic the ex vivo 3-D culturing.With the theological analysis,cyto-morphological observation was performed,NSCs proliferation was observed by MTT assay,and cell immunochemistty and confocal microscopy were employed to detect the NSCs differentiation.Results SAPNH born appropriate elastic module conducive to the cellular adhesion and proliferation of neural cells (RADA16 and RADA16-c (RGDfK)=(0.42±0.07) kPa and (0.47 ±0.09) kPa,without significant difference (P＞0.05); however,the elastic module in the type Ⅰ collagen group was (0.87±0.12) kPa,which was significantly stronger than the two groups (P＜0.05).Uniform distribution of neuron-shape cells was noted in the extracellular matrix ofRADA16-c (RGDfK) cells,with almost the diameter of cell sphere (200-300 μm); cells in the RADA16 and RADA16-c (RGDfK) had better growth characteristics than the other two groups; RADA16-c(RGDfK) had significantly better cellular adhesion and proliferation of neural cells as compared with RADA16 and collagen groups (P＜0.05).A large number of neural precursor cells differentiated into neurogliocytes was noted in the RADA16 group and RADA16-c (RGDfK) group,with low proportion of neuronal differentiation (17.6％ ±3.1％ and 19.0％±3.6％,respectively); this proportion of neuronal differentiation was significantly higher than that in the type Ⅰ collagen group (10.6％±2.3％,P＜0.05).Conclusions The functionalized SAPNH enhanced with c(RGDfK) presents the excellent biocompatibility and promotes the adhesion and proliferation of spinal NSCs.Serving as the engineered cellular vector,functionalized SAPNH has laid a solid foundation for the studies of neural regeneration and repair with novel neuro-engineering techniques in the subsequent researches.

Objective To compare the effect of rubber ring versus dental floss combined with hemoclipping assisted en-doscopic submucosal dissection(ESD)in the treatment of early gastrointestinal tumor.Methods A total of 103 patients with early gastrointestinal cancer were divided into the rubber band traction group(rubber band group,n=51)and the dental floss traction assist group(dental floss group,n=52)according to different assisted traction techniques during ESD.The basic con-ditions of the two groups were compared before operation,as well as the amount of submucosal injection,installation time of the traction device,the amount of bleeding during operation,the time of operation,the delayed bleeding after operation,one-time complete resection rate of tumor,days in hospital after operation and complication rate at 72 hours after operation.The degree of postoperative pain(VAS pain Score),follow-up quality of life(SF-36 Score)and complications 12 months after op-eration were also recorded.Results The intraoperative submucosal injection volume,intraoperative bleeding volume,num-ber of hemostatic clamp detachment,surgical time,complication rate 72 hour after operation and postoperative hospital stay were lower in the rubber band group than those in the dental floss group(P＜0.05).There was no significant difference in the number of delayed postoperative bleeding between the two groups(P＞0.05).After 12 months of follow-up,patients in the rubber band group had mild postoperative pain and good quality of life.The incidence of complications decreased within 12 months after surgery in the rubber band group(P＜0.05).Conclusion Compared with floss traction aid,rubber ring traction aid ESD can shorten the operation time and reduce postoperative complications,which is worth popularizing.

Objective:To investigate the regulatory effects and mechanism of mannan-binding lectin (MBL) on adipogenic differentiation of 3T3-L1 preadipocytes.Methods:3T3-L1 preadipocytes were induced to differentiate into adipocytes in vitro, and stimulated with different concentrations of MBL (0, 1, 10, 20 μg/ml). Firstly, changes in cell proliferation ability were detected by CCK-8. Then lipid accumulation was analyzed by Oil red O staining and intracellular triglyceride content determination. Further, the expression of adipogenic differentiation-related factors PPARγ and C/EBPα at protein and mRNA levels were detected by Western blot and qRT-PCR, respectively. Finally, Western blot was used to analyze the expression and phosphorylation of Akt, a signal molecule related to adipogenic differentiation. Results:MBL at the concentrations of 0, 1, 10 and 20 μg/ml had no effect on the proliferation of 3T3-L1 preadipocytes. The level of triglyceride in MBL treatment groups decreased in a dose-dependent manner on 3 d after 3T3-L1 preadipocyte differentiation. Results of Oil red O staining showed that the number of lipid droplets in MBL treatment groups reduced significantly, and the absorbance values also decreased significantly in a concentration-dependent manner. Western blot and qRT-PCR results showed that the expression of PPARγ and C/EBPα at both protein and mRNA levels in MBL treatment groups decreased significantly in a dose-dependent manner, and the phosphorylation level of Akt was significantly down-regulated as well.Conclusions:MBL regulates the adipogenic differentiation of 3T3-L1 preadipocytes via Akt signaling pathway.

Objective To investigate the regulation of Treg/Th17 axis by mannan-binding lectin (MBL) in mice with Candida albicans ( C. albicans ) infection. -ethods MBL gene-knockdown (MBL-/-) C57BL/6 mice and wild-type (WT) C57BL/6 mice were divided into four groups. C. albicans strains (2×107 CFU) were injected intraperitoneally into the mice of infection groups. Paraffin sections of mouse liver and kidney tissues were prepared on 3 d. Histopathological changes were observed with hematox-ylin and eosin ( HE) and Periodic acid-Schiff ( PAS) staining. Flow cytometry was performed to analyze Th17 and Treg cells in mice on 7 d. The levels of IL-10 and IL-17A were measured by ELISA. CD4+T cells were obtained from spleen cells by magnetic sorting. Expression of Foxp3 and RORγt at mRNA and protein levels were detected by qRT-PCR and Western blot, respectively. Results The mouse model of C. albicans infection was established successfully. After infection, the MBL-/- mice had higher percentages of Th17 cells, but lower percentages of Treg cells than the WT mice. ELISA results showed that compared with the WT mice with C. albicans infection, the MBL-/- mice had significantly increased IL-17A and decreased IL-10 after infection. Moreover, the expression of RORγt at both mRNA and protein levels was up-regula-ted, while that of Foxp3 was down-regulated in the MBL-/- mice than in the WT mice following infection. Conclusions MBL regulates the immune balance of Treg/Th17 cells in mice infected with C. albicans through promoting the differentiation of CD4+ T cells into Treg cell subsets and inhibiting the differentiation into Th17 cell subsets.