Objective To assess the efficacy of internal fixation assisted with Halo-vest in the treatment of Anderson-D'Alonzo type Ⅱ and superficial type Ⅲ odontoid fractures.Methods A retrospective case series study was made on 15 patients clinically diagnosed as Anderson-D'Alonzo type Ⅱ and type Ⅲ odontoid fractures with a fracture gap over 2 mm,displacement over 5 mm and broken end angel over 11° from January 2007 to January 2015.There were nine males and six females,aged 27-61 years [(44.5 ± 10.9)years].The patients were treated in "three phases" with the assistance of Halo-vest external fixation system and a novel guide pin aiming device.The three phases were as follows:phase Ⅰ:cervical traction reduction and halo-vest external fixation;phase Ⅱ:Halo-vest assisted internal fixation using the novel aiming device;phase Ⅲ:the Halo-vest fixation removal and cervical collar fixation.Operation duration,intraoperative bleeding,and postoperative visual analogue scale (VAS) pain score one month after the operation were recorded.The cervical lateral and open mouth X-ray or atlantoaxial CT scan with sagittal and coronal two-dimensional reconstruction were regularly reviewed,and the location of screws,reduction and fracture healing were evaluated.Results Operation duration ranged from 54 to 96 minutes [(71.3-± 11.9) min].The intraoperative blood loss was 5-60 ml [(32.6 ± 16.8) ml].There was no spinal cord or nerve root injury,cerebrospinal fluid leakage,wound infection or other complications.All patients were followed up for 12-36 months (mean,28 months).Fourteen patients were seen bony union 6 months after the surgery and one patient was seen a false joint.At the last follow-up,the patient with false joint was seen bone sclerosis,and other patients with sound bone healing.The preoperative VAS and that of one month after the operation was (7.3 ± 0.6) points and (1.6 ± 0.7) points,respectively (P ＜ 0.05).Conclusion For Anderson-D'Alonzo type Ⅱ and type Ⅲ odontoid fractures,which have a fracture gap greater than 2 mm,displacement more than 5 mm,broken end angle above 11 degrees,the three-phase Halo-vest assisted internal fixation can provide good stability before operation and promote bone healing and pain relief after operation.

Objective:To investigate the feasibility and clinical efficacy of posterior vertebral column resection (PVCR) combined with polymethylmethacrylate-augmented pedicle screw instrumentation and shortening of spinal column for stage Ⅲ Kümmell's disease with very severe collapse of fractured vertebra.Methods:From January 2017 to September 2021, 9 patients with stage Ⅲ Kümmell's disease with very severe collapse of fractured vertebra underwent PVCR combined with polymethylmethacrylate-augmented pedicle screw instrumentation and shortening of spinal column. Their medical records were retrospectively analyzed. There were 1 male and 8 females, aged (66.9±5.8) years. The injured vertebra was located at T 11 in 2 patients, at T 12 in 4, at L 1 in 2 and at L 2 in 1. X-ray, CT and MRI were performed before operation. The posterior intervertebral heights of adjacent vertebral bodies of the fractured vertebra in the median sagittal position were measured on CT or MRI to evaluate the shortening of the spinal column before PVCR. Recorded were intraoperative bleeding volume, operation time, complications, bone graft fusion, and American Spinal Injury Association (ASIA) grading at preoperation and the last follow-up. The visual analogue scale (VAS) pain scores, Oswestry disability index (ODI) scores, and kyphotic cobb angles at preoperation, 1 week and 3 months postoperation, and the last follow-up were compared to evaluate the clinical efficacy of PVCR. Results:All patients underwent surgery successfully, with tight closure of adjacent vertebrae after resection of the injured vertebra and bone grafting. Operation time was (240.6±23.2) min and intraoperative bleeding (505.6±95.0) mL. The 9 patients were followed up for (17.3±5.6) months. No worsening symptoms of nerve injury, cerebrospinal fluid leakage, or other serious complications were found after operation, nor such complications as loosening or breakage of internal fixation or adjacent vertebral fractures. Bone fusion was achieved at the bone graft sites in all patients by the last follow-up. The VAS and ODI scores and cobb angles at 1 week and 3 months postoperation and at the last follow-up were significantly decreased compared with preoperation ( P<0.05). There were no significant differences in VAS scores or cobb angles among postoperative 1 week and 3 months and the last follow-up ( P>0.05), but pairwise comparisons between different time points after operation showed significant differences in ODI, with postoperative 1 week > postoperative 3 months > the last follow-up ( P<0.05). The ASIA grading at the last follow-up was improved from preoperative grade C to grade D in 2 cases, from preoperative grade C to grade E in 1 case and from preoperative grade D to grade E in 5 cases. Conclusion:PVCR combined with polymethylmethacrylate-augmented pedicle screw instrumentation and shortening of spinal column is a feasible and effective surgical treatment for stage Ⅲ Kümmell's disease with very severe collapse of fractured vertebra, leading to good clinical efficacy.

Objective To identify long non-coding RNA (lncRNA) associated with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and investigate their mechanisms. Methods Peripheral blood samples were collected from RA-ILD patients (n＝3), RA patients without lung involvement (n＝3), and healthy controls (n＝3). Next-generation sequencing was performed to screen differentially expressed lncRNA. A human fibrotic lung cell model was established by inducing the MRC-5 cell line with transforming growth factor-β (TGF-β). Following siRNA-mediated knockdown of target genes, changes in inflammatory and oxidative stress-related genes were analyzed via real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). Western blotting and dual-luciferase reporter (DLR) assays were used to validate protein expression, ubiquitination levels, and nuclear translocation of oxidative stress regulators, and antioxidant response element (ARE) transcriptional activity. Rescue experiments were conducted to confirm the role of target lncRNA in oxidative stress and inflammation in fibrotic lung cells. Results High-throughput sequencing revealed significant downregulation of LINC00638 in RA-ILD patients. Knockdown of LINC00638 markedly reduced transcriptional levels of interleukin (IL)-4, nuclear factor erythroid-2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), and superoxide dismutase 2 (SOD2), while increasing IL-6, IL-1β, interferon-γ (IFN-γ), and reactive oxygen species (ROS) levels. Furthermore, LINC00638 knockdown decreased Nrf2 protein expression, increased its ubiquitination, reduced nuclear translocation, and suppressed ARE transcriptional activity. In MRC-5 cells, LINC00638 knockdown combined with N-acetylcysteine treatment restored Nrf2 and HO-1 levels while reducing IL-6 expression. Conclusions LINC00638 suppresses inflammatory responses in RA-ILD by activating the Nrf2/ARE antioxidant signaling pathway, suggesting its potential as a therapeutic target for diagnosis and treatment.