BACKGROUND: It is currently believed that myocardial mitochondrial structure and function damage play a key role in sepsis-induced myocardial dysfunction. OBJECTIVE: To construct a rat model of sepsis-induced myocardial dysfunction and provide an effective experimental method for studying the disease. METHODS: Seventy-two SPF male Sprague-Dawley rats were randomly divided into control group (n-28) and lipopolysaccharide (LPS) group (n=44). Twenty rats were randomly selected from each group for observation of 10 days of survival. According to the post-modeling phase, the remaining 24 rats of the LPS group were divided into three subgroups, LPS 6-hour group, LPS 12-hour group and LPS 24-hour group, with 8 rats in each group. A sepsis model was constructed by intraperitoneal injection of 10 mg/kg LPS in the LPS group, and the control group was injected with an equal volume of normal saline. Echocardiographic examination of cardiac function was performed at each phase in each LPS subgroup. Myocardial histopathological morphology was observed by light microscopy, and myocardial ultrastructure was observed by transmission electron microscopy. Serum cardiac troponin and brain natriuretic peptide levels were measured by ELISA. The study was approved by the Ethic Committee of General Hospital of Ningxia Medical University in China (approval No. 2018-320). RESULTS AND CONCLUSION: Compared with the control group, the 10-day survival rate of rats in the LPS subgroups was lower. Compared with the control group, there was no reduction in left ventricular ejection fraction and left fractional shortening in the LPS 6-hour group (both P > 0.05). While in the LPS 12-hour group and LPS 24-hour group, the left ventricular ejection fraction and left fractional shortening significantly decreased (all P < 0.01), and the decrease was more obvious with time (all P < 0.01). Compared with the control group, the serum cardiac troponin and brain natriuretic peptide levels were significantly increased in the LPS 12-hour group and LPS 24-hour group (all P < 0.01), and the serum cardiac troponin and brain natriuretic peptide levels gradually increased with LPS injection time (all P < 0.01). The myocardial pathological morphology and ultrastructure of the LPS subgroups showed obvious damage compared with the control group, and the damage was more obvious with the prolongation of LPS injection time. In this experiment, we successfully constructed a stable and reliable model of sepsis-induced myocardial dysfunction in rats, which is an ideal animal model for clinical research of sepsis cardiomyopathy.

Background Di(2-ethylhexyl)phthalate (DEHP) and dibutyl phthalate (DBP) are representative environmental endocrine disruptors of phthalate esters (PAEs). Some studies have shown that PAEs exposure may have an impact on lipid metabolism. Objective To investigate the effects of DEHP and/or DBP on lipid metabolism in rats and their possible mechanisms of action. Methods Thirty-six weaned healthy SD male rats, 3 weeks old, weighing 50-70 g, were divided into four groups, i.e., a corn oil control group, a DEHP (750 mg·kg⁻¹) group, a DBP (500 mg·kg⁻¹) group, and a DEHP+DBP (750 mg·kg⁻¹+500 mg·kg⁻¹) group. The rats were exposed to DEHP and/or DBP by oral gavage for 8 weeks, and weighed once a week. The rats were anesthetized 24 h after the last dose, and blood was taken from the apical part of the heart. Serum high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), total cholesterol (TC), and triglyceride (TG) were detected. Liver tissues and perigenital adipose tissues were collected, weighed, and one portion of the tissues was fixed in 10% neutral formalin for pathomorphological observation, and another portion was used for mRNA detection of lipid metabolism-related genes such as Janus kinase 3 (JAK3), signal transducer and activator of transcription 5b (STAT5b), and peroxisome proliferator-activated receptor γ (PPARγ). Results During the DEHP and/or DBP exposure period, the rats in all groups were free to eat and drink without death or injury observed. Compared with the control group: The body weight gain in the DEHP+DBP group was lower at all time points from the 2nd week onwards (P<0.05); the liver organ coefficients of the DEHP and the DEHP+DBP groups were higher (P<0.05); the serum LDL-C levels in the DEHP and the DBP groups were higher (P<0.05). Compared with the DEHP+DBP group: The body weight gains in the DEHP group at the 2nd, 4th, 5th, and 8th weeks were higher (P<0.05), and the body weight gains in the DBP group were higher at all time points except the 1st week (P<0.05); the liver organ coefficients in the DEHP group and the DBP group were lower (P<0.05); the serum TG level in the DEHP group was higher(P<0.05), and the serum LDL-C levels in the DEHP and the DBP groups were higher (P<0.05). The pathomorphological results of liver tissues showed that the hepatocytes in the DEHP, DBP, and DEHP+DBP groups were disordered with loss of cord-like arrangement, swelling (suggesting change of cell proliferation), and presented bilirubin pigmentation. The pathomorphological results of rat perigenital adipose tissues showed had irregular alignment, sizes, and arrangement of adipocyte in the DEHP, DBP, and DEHP+DBP groups. The results of rat liver lipid metabolism-related gene mRNA levels showed that the liver JAK3, STAT5b, and PPARγ mRNA levels in the DEHP, DBP, and DEHP+DBP groups were lower than those in the control group (P<0.05); the rat liver PPARγ mRNA levels in the DEHP and DBP groups were lower than those in the DEHP+DBP group (P<0.05). Conclusion DEHP and/or DBP can inhibit the increase of body weight to varying degrees, induce inflammatory damage to liver tissues, and cause abnormal lipid metabolism in rats, and the associated mechanism may be related to inhibiting the activation of JAK3/STAT5b/PPARγ signaling pathway in rat liver tissues.

[摘 要] 目的：探讨环化自erb-b2受体酪氨酸激酶2（ERBB2）基因的circ_0007766分子在前列腺癌（PCa）细胞中的作用及缺氧对其表达调控的影响。方法：qRT-PCR检测circ_0007766分子在PCa细胞及组织中的表达；分别转染circ0007766的siRNA至PCa细胞DU145和PC3中，平板克隆实验、CCK-8实验和Transwell 实验检测circ_0007766敲低对PCa细胞克隆形成、增殖、迁移和侵袭能力的影响；厌氧袋法建立DU145和PC3细胞的缺氧细胞模型，WB法检测缺氧通路关键分子HIF-1α的蛋白表达，qRT-PCR检测缺氧模型细胞中circ_0007766分子的表达，WB检测RNA结合蛋白真核翻译起始因子4A3（EIF4A3）的蛋白水平表达，RNA免疫沉淀（RIP）法检测缺氧条件下EIF4A3与circ_0007766的结合，qRT-PCR进一步检测缺氧条件下敲低EIF4A3对circ_0007766表达的影响。结果：circ_0007766在PCa细胞（P < 0.01）及PCa组织（P < 0.05）中呈高表达；敲低circ_0007766（P < 0.05或P < 0.01）能显著抑制PCa细胞的增殖、迁移和侵袭能力（均P < 0.01）。缺氧条件下HIF-1α蛋白表达增加，表明缺氧细胞模型建立成功。qRT-PCR检测结果显示，相较于常氧组，缺氧组circ_0007766的表达显著升高（P < 0.01），WB法检测结果显示缺氧组细胞中EIF4A3 的蛋白表达增强。RIP实验结果显示，circ_0007766在EIF4A3富集组高度富集（P < 0.01）。qRT-PCR检测结果显示，缺氧可显著促进circ_0007766的表达，同时，敲低EIF4A3分子可显著降低缺氧诱导的circ_0007766的表达（P < 0.05或P < 0.01）。结论: circ_0007766在PCa细胞中扮演着促癌分子的角色，其表达形成与缺氧条件下EIF4A3分子的调控有关。

Background The pathogenesis of silicosis has not been fully elucidated, and microRNAs (miRNA) may be involved in the occurrence and development of silicosis. Objective To investigate the effect of miR-204-3p inhibitor on the epithelial-mesenchymal transition (EMT) process and silicosis fibrosis in silicon dioxide dust-induced alveolar epithelial cells. Methods A co-culture model of macrophages and epithelial cells was established using a Transwell chamber. NR8383 macrophages were seeded into the upper chamber of the Transwell, and RLE-6TN cells were seeded into the lower chamber. After 24 h of culture, the medium in the lower chamber was discarded, washed three times with phosphate-buffered saline (PBS), and replaced with serum-free medium. The cells were divided into four groups: control group, silicosis group, miRNA NC group, and miR-204-3p inhibitor group. The lower chamber was transfected with miRNA NC for the miRNA NC group or the miR-204-3p inhibitor for the miR-204-3p inhibitor group. The lower chambers of the remaining two groups were added by equal amounts of serum-free medium. After 24 h, except for the control group that received an equal volume of serum-free medium, the upper chambers of the remaining three groups were treated with 800 μg·mL⁻¹ silicon dioxide dust. Morphological changes in each group were observed under a microscope. The mRNA and protein expression levels of EMT-related factors, including α-smooth muscle actin (α-SMA), Vimentin, N-Cadherin, and E-Cadherin, were detected by reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) and Western blot. The mRNA and protein expression levels of fibrosis-related factors, including Collagen I, Collagen III, and Fibronectin, were also assessed by RT-qPCR and Western blot. The fluorescence expression intensities of α-SMA, N-Cadherin, and E-Cadherin were evaluated by immunofluorescence. Results The morphological observation revealed that RLE-6TN cells in the control group exhibited a regular oval shape. After treatment with silicon dioxide, the cells predominantly displayed a long spindle shape. Following the intervention with the miR-204-3p inhibitor, the number of long spindle-shaped cells increased, and the intercellular gaps widened. The RT-qPCR results showed that, compared with the control group, the silicosis group exhibited significantly higher relative mRNA expression levels of EMT-related markers (α-SMA, Vimentin, and N-Cadherin) (P<0.05), while the relative mRNA expression level of E-Cadherin was significantly reduced (P<0.05); the relative mRNA expression levels of fibrosis-related markers (Collagen I, Collagen III, and Fibronectin) were also significantly elevated (P<0.05). Compared with the miRNA NC group, the miR-204-3p inhibitor group showed significantly increased relative mRNA expression levels of α-SMA, Vimentin, and N-Cadherin (P<0.05), decreased E-Cadherin mPNA expression (P<0.05), and elevated mPNA expression of Collagen I, Collagen III, and Fibronectin (P<0.05). The Western blot analysis indicated that, compared with the control group, the silicosis group had significantly higher protein expression levels of α-SMA, Vimentin, and N-Cadherin (P<0.05), lower E-Cadherin protein expression (P<0.05), and increased protein expression of Collagen I, Collagen III, and Fibronectin (P<0.05). Compared with the miRNA NC group, the miR-204-3p inhibitor group exhibited significantly elevated protein expression levels of α-SMA, Vimentin, and N-Cadherin (P<0.05), reduced E-Cadherin expression (P<0.05), and increased protein expression of Collagen I, Collagen III, and Fibronectin (P<0.05). The immunofluorescence analysis demonstrated that, compared with the control group, the silicosis group showed enhanced fluorescence intensities of α-SMA and N-Cadherin and reduced fluorescence intensity of E-Cadherin. Compared with the miRNA NC group, the miR-204-3p inhibitor group exhibited increased fluorescence intensities of α-SMA and N-Cadherin and decreased fluorescence intensity of E-Cadherin. Conclusion The miR-204-3p inhibitor may exacerbate the EMT process and silicosis fibrosis in silicon dioxide-induced RLE-6TN cells. miR-204-3p plays a negative regulatory role in silicosis fibrosis.

BACKGROUNDTo assess the sensitivity and specificity of flow cytometry (FCM) DNA content analysis in diagnosing malignancy as well as premalignancy and to evaluate the diagnostic role of FCM DNA content analysis in fiberoptic bronchoscopic specimens of lung cancer.

METHODSFresh specimens taken by fiberoptic bronchoscope from 41 patients with lung cancer (28 squamous cell carcinoma, 2 bronchioloalveolar carcinoma, 11 small cell lung cancer) and 21 patients with non-malignant pulmonary lesions were measured for DNA index (DI), S-phase fraction (SPF) by using FACSCalibur 4200 flow cytometry. The diagnostic value of this method was compared with fiberoptic bronchoscopic biopsy, brushing and sputum examination.

RESULTS1. DI was 1.18±0.33 and 0.99±0.07 in lung cancer and non-malignant groups respectively. The percentage of heteroploid was 78.04% in lung cancer and 4.8% in non malignant. DI and the positive rate of heteroploid in lung cancer group were significantly higher than that in non-malignant group ( P < 0.01). If the presence of heteroploid was used as a diagnostic criterion, the sensitivity of DNA analysis was 78.04% and the specificity was 95.24%. There was no diagnostic sensitivity difference between FCM DNA content analysis and biopsy (90.26%) ( P > 0.05), as well as brushing (65.85%) ( P > 0.05). 2.Athough DI and the rate of heteroploid increased as the pathological grade and TNM stage advanced, there were no significant differences ( P > 0.05). 3. SPF in lung cancer group was significant higher than that in non-malignant group. The SPF of heteroploid tumors was higher than that of diploid tumors ( P < 0.05); SPF correlated with TNM stage ( P < 0.05).

CONCLUSIONSFCM DNA content analysis has an adjunctive value in diagnosis of lung cancer. The analysis of DNA content and SPF by FCM provides a beneficial method for the evaluation of tumor behavior.

【Objective】 To explore the effects of anti-inflammatory of short-chain fatty acids in human peripheral blood mononuclear cells （THP-1） and chronic obstructive pulmonary （COPD） mice. 【Methods】 We adopted the methods of qRT-PCR， ELISA， Western blotting， HE staining and Sirius staining to detect the changes of inflammatory factors in THP-1 cells and COPD with or without short-chain fatty acids. 【Results】 The ELISA and qRT-PCR experiments showed that the serum inflammatory factors， including interleukin-6 （IL-6）， interleukin-1β （IL-1β） and tumor necrosis factor-α （TNF-α）， were higher in clinical COPD patients than in healthy people. And the THP-1 cells expressed these inflammatory factors highly after LPS stimulation. Among three short-chain fatty acids treated， butyrate could reduce the levels of inflammatory factors better than acetate and propionate. After COPD mice were treated with butyrate in the drinking water， the mRNA expressions of inflammatory factors IL-6， IL-1β and TNF-α in the lung tissue decreased， and the concentrations of IL-6 and IL-1β in plasma decreased. The protein detection results showed that the phosphorylation expression of NF-κB decreased， and butyrate might inhibit the expressions of inflammatory factors by inhibiting the NF-κB signaling pathway. 【Conclusion】 The SCFA butyrate can inhibit LPS-induced inflammatory response of THP-1 cells and have an inhibitory effect on inflammation in COPD mice.

Background The contribution of long-term ambient PM_2.5 exposure to hypertension should not be ignored. However, the conclusions of whether dietary factors play a role in regulating PM_2.5-related hypertension are still inconsistent. Objective To explore the correlation between long-term exposure to ambient PM_2.5 and blood pressure indicators (systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure) in adults in Ningxia and a potential moderating effect of dietary factors. Methods A set of cross-sectional survey data from March, 2013 to May, 2018 was retrieved from the China Northwest Cohort-Ningxia, and the average ambient PM_2.5 concentration in the previous three years was also collected to estimate the long-term exposure of the participants. Binary logistic regression model was used to validate the correlation between long-term exposure to ambient PM_2.5 and hypertension in Ningxia, and linear model was used to study the correlation between long-term exposure to ambient PM_2.5 and blood pressure indicators (systolic blood pressure, diastolic blood pressure, mean arterial pressure and pulse pressure), and to explore the influence of dietary factors on ambient PM_2.5-related hypertension. Results A total of 11470 participants were included in the study, 42.2% male and 57.8% female. The three-year average ambient PM_2.5 concentration before the baseline survey was 37.0 μg·m⁻³. Each 1 μg·m⁻³ increase in ambient PM_2.5 was associated with an increased risk of hypertension (OR=1.111, 95%CI: 1.097, 1.125), and increased systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure by 0.886 (95%CI: 0.783, 0.990), 0.570 (95%CI: 0.500, 0.641), 0.676 (95%CI: 0.600, 0.751), and 0.316 (95%CI: 0.243, 0.389) mmHg, respectively. The stratified analysis showed that the OR and 95%CI of hypertension were 1.171 (1.097, 1.254), 1.117 (1.064, 1.174), and 1.160 (1.116, 1.207) respectively for each 1 μg·m⁻³ increased in PM_2.5 with low frequency of vegetable and fruit consumption and salty taste respectively. The OR and 95%CI of hypertension were decreased when the moderate and high frequency of vegetable and fruit intake and moderate and light taste applied, the values were 1.091 (1.062, 1.121) and 1.114 (1.097, 1.131), 1.105 (1.082, 1.129) and 1.111 (1.092, 1.13), 1.115 (1.090, 1.140) and 1.102 (1.083, 1.121) respectively. Compared with low frequency of vegetable and fruit intake and salty taste, the increase degree of ambient PM_2.5 related systolic blood pressure, diastolic blood pressure, mean arterial pressure and pulse pressure also decreased in middle and high frequency of vegetable and fruit intake and moderate and light taste. Conclusion Long-term exposure to ambient PM_2.5 is significantly associated with increased risks of hypertension and blood pressure in Ningxia area. Increasing the frequency of vegetable and fruit intake and decreasing salty taste may reduce the effect of ambient PM_2.5 on hypertension and blood pressure.

[摘 要] 目的：探讨miR-153-3p对胃癌SGC7901细胞增殖、侵袭和迁移的作用及其机制。方法：收集2018年5月至2020年6月宁夏医科大学总医院收治的60例胃癌患者的癌和配对癌旁组织标本，以及人胃癌细胞系NCI-N87、AGS、SNU-5、SGC7901和胃上皮细胞GES-1，qPCR法检测miR-153-3p在胃癌组织与细胞中的表达水平。将miR-153-3p mimic及mimic对照序列转染至SGC7901细胞，用CCK-8、克隆形成、流式细胞术、TUNEL、Transwell和划痕愈合实验分别检测上调miR-153-3p对SGC7901细胞增殖、凋亡、侵袭和迁移的影响。构建裸鼠SGC7901细胞移植瘤模型，观察miR-153-3p对肿瘤生长的影响。通过生物信息学数据库和双荧光素酶报告基因实验预测并验证miR-153-3p与FZD3靶向关系，WB法检测miR-153-3p对FZD3蛋白及Wnt/β-catenin通路相关蛋白表达的影响。结果：miR-153-3p在胃癌组织和细胞中表达水平分别显著低于癌旁组织和GES-1细胞（均P<0.01），以SGC7901细胞中表达水平最低。上调miR-153-3p显著抑制SGC7901细胞的增殖、侵袭和迁移能力，并提高细胞凋亡率（均P<0.01），同时上调细胞中E-cadherin表达而下调N-cadherin、MMP2和MMP9表达（均P<0.01）。在体内实验表明，静脉注射miR-153-3p mimic显著降低移植瘤体积和瘤组织中Ki-67表达而上调P57表达（均P<0.01）。机制分析表明，miR-153-3p靶向结合FZD3基因的3′UTR区域，上调miR-153-3p会抑制FZD3表达并上调β-catenin、TCF-4和cyclin D1水平（均P<0.01）。结论：miR-153-3p靶向FZD3并通过Wnt/β-catenin信号通路调控胃癌SGC7901细胞的增殖、侵袭和迁移。

OBJECTIVETo explore beryllium oxide induced oxidative lung injury and the protective effects of LBP.

METHODSIntoxication of animals were induced by once intratracheal injection and LBP intervention by intragastric administration. The content of HIF-1, VEGF and HO-1 of lung tissues were measured by kits. The pathological changes of lung tissue were showed by pathological section. The changes of lung ultrastructure were observed by electron microscope.

RESULTSPathological changes of the lung tissue in beryllium oxide exposure group rats were in line with the characteristics of beryllium disease in human. Compared with the control group, HO-1 was increased in beryllium oxide exposure 40 d group and low doses of LBP group, compared with the control group, HO-1 was increased in beryllium oxide exposure 80d group and LBP treatment groups (P < 0.05 or P < 0.01). Compared with the control group, HIF-1 was increased in beryllium oxide exposure 40 d group, LBP treatment groups, beryllium oxide exposure 60 d and 80 d groups (P < 0.05 or P < 0.01). Compared with the control group, VEGF was increased of all phases, especially in beryllium oxide exposure 40d and 80 groups, LBP treatment groups and beryllium oxide exposure 60 d (P < 0.05 or P < 0.01). The content of HO-1 of beryllium oxide exposure group was higher than the LBP treatment for 40d group but below LBP treatment for 80 d group (P < 0.05). The content of HIF1 of beryllium oxide exposure group was higher than high dose of LBP treatment for 60d group and LBP treatment for 80 d group (P < 0.01). The content of VEGF of beryllium oxide exposure group was higher than LBP treatment for 40 d group and high dose of LBP treatment for 60 d (P < 0.05 or P < 0.01).

CONCLUSIONSBeO can cause abnormal expression of related genes of lung tissue in rats, LBP has protective effects on BeO caused lung injury.

Acute Lung Injury ; chemically induced ; physiopathology ; Acute-Phase Proteins ; pharmacology ; Animals ; Beryllium ; toxicity ; Carrier Proteins ; pharmacology ; Heme Oxygenase (Decyclizing) ; metabolism ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Lung ; drug effects ; pathology ; Membrane Glycoproteins ; pharmacology ; Oxidative Stress ; Protective Agents ; pharmacology ; Rats ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVE: To evaluate the efficacy of oblique lumbar interbody fusion combined with unilateral pedicle screw fixation via Wiltse approach in the treatment of lumbar spinal stenosis. METHODS: From July 2017 to January 2019, 90 patients with lumbar spinal stenosis, including 38 males and 52 females, aged from 43 to 75 years old with an average of(59.9±8.8) years old, and were treated with oblique lumbar interbody fusion(OLIF) combined with Wiltse unilateral pedicle screw fixation. Surgical decompression and fixation was performed in 50 cases of single segment, 32 cases of double segments and 8 cases of three segments. The distribution of responsible segments included 8 cases of L₂-L₃, 12 cases of L₃-L₄ and 30 cases of L₄-L₅ on single segment, 10 cases of L₂-L₄ and 22 cases of L₃-L₅ on double segments, and 8 cases of L₂-L₅ on three segments. The operation time, blood loss and occurrence of complications were recorded, Visual analogue scale(VAS), Oswestry Disability Index(ODI) and SF-36 scale were used to evaluate clinical efficacy. Lumbar X-ray and MRI were taken at three days after operation, interverterbral space height, intervertebral foraminal height, interverterbral foraminal area, and spinal canal area were measured, and interbody fusion was evaluated according to CT at half a year after operation. RESULTS: All patients were followed up from 12 to 33 months, with an average of (20.2±6.6) months. Mean operation time was (103.3±35.9) min, and mean intraoperative blood loss was (70.4±17.8) ml. VAS of low back pain leg pain, and ODI decreased from 6.2±1.1, 6.1±0.9 and (59.9±4.2)% to 2.7±0.5, 2.5±0.5 and (31.3±8.8)%. SF-36 scale significantly increased from (37.2±3.1) to (54.9±6.1) at the six months postoperation(P<0.05). The intervertebral space height, intervertebral foraminal height, intervertebral foraminal area, and spinal canal area were significantly improved at 3 days after operation(P<0.05). Six months after operation, CT scan showed well fusion in 87 cases, but 3 cases with poor fusion, including 1 case of single segment, 2 cases of multi-segments. The total fusion rate was 96.7% (87/90), the single segment fusion rate was 98.0% (49/50), and the multi-segments fusion rate was 95.0%(38/40). The overall incidence of complications was 17.8%(16/90), including transient iliopsoas muscle weakness in 5 cases (5.6%), endplate fracture in 2 cases (2.2%), peritoneal injury in 1 case (1.1%), postoperative hematoma in 1 case (1.1%), adjacent segment disease in 1 case(1.1%), and fusion cage subsidence in 6 cases (6.7%). Three patients was followed up for recurrent nerve root pain and the symptoms were relieved after revision operation. All complications were relieved or disappeared in varying degrees during the follow-up period, and there were no complications such as cage displacement and screw fracture. CONCLUSION OLIF combined with unilateral pedicle screw fixation via Wiltse approach is effective in treating lumbar spinal stenosis with minimally invasive advantages such as less trauma and less complications. Under the premise of strictly grasping the indications, this method could also achieve satisfactory clinical results in multi-segments oprations.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Spinal Stenosis/surgery* ; Pedicle Screws ; Spinal Fusion/methods* ; Lumbar Vertebrae/surgery* ; Treatment Outcome ; Low Back Pain