Objective This study was designed to determine the influence of acute ethanol intoxication (AEI) on brain edema and aquaporin-4(AQP-4) levels after traumatic brain injury(TBI) in rots. The underlying mechanism was also investigated. Method Severe traumatic brain injury models were made using the Feeny method; acute ethanol intoxication models were established by gavagy. One hundred and ninety-two male SD rats were randomly divided(random number) into four groups, namely the sham operation group(A ), the acute ethanol intoxication group( B ), the traumatic brain injury group(C) and the combination of acute ethanol intoxication with traumatic brain injury group(D). Each group was further divided into four sub-groups according to the time interval between injury and death of the rats. After brain tissue was fixed by affusing paraformaldehyde, the expression of AQP-4 was detected by immunohistochemistry. Water content was detected by dry-wet analysis, and AQP-4 mRNA and protein were detected by RT-PCR and western blotting respectively after the brain tissue was got by rapid decapitation. Data were analyzed by one-way ANOVA. Results The water content of brain tissue and expression level of AQP-4 were not significantly different between groups A and B( P > 0.05); however both were significantly increased in groups C and D relative to group A( P < 0.05). The water content of brain tissue in group D increased by mere than that in group C( P < 0.05), while the expression level of AQP-4 in group D was lower than that in group C(P<0.05). Conclusions Acute ethanol intoxication inhibited the expression of AQP-4,which induced a more severe cerebral edema after traumatic brain injury.

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.

BACKGROUND:It is confirmed that astrocytes can differentiate into neurons by Neurogenin2 gene regulation, suggesting that Schwann cells may also differentiate into neurons by gene regulation.
OBJECTIVE:To evaluate the feasibility of Schwann cells differentiating into neurons by Neurogenin2 gene regulation.
METHODS:Rats Schwann cells were isolated, purified and identified. Then the Schwann cells were transfected with Neurogenin2 via green fluorescent protein gene-plentivirus. To induce neuronal differentiation, the Schwann cells were cultured in serum-free Dulbecco’s modified Eagle’s medium containing epidermal growth factor, basic fibroblast growth factor and brain-derived neurotrophic factor for 2 weeks. The morphology of induced cells was observed by microscope, and myelin basic protein and neuron-specific enolase were detected by immunocytochemistry.
RESULTS AND CONCLUSION:After transfection with Neurogenin2 via green fluorescent protein gene-plentivirus and induced differentiation, immunofluorescence assay demonstrated that 12.56%of the induced cellexpressed neuron-specific enolase, but the control group did not express neuron-specific enolase. Neurogenin2 gene-transfected Schwann cells can express neuron-specific enolase, suggesting Neurogenin2 gene may regulate transdifferentiation of Schwann cells into neurons.

Objective To investigate the clinical efficacy of radiofrequency surgical therapy combined with ozone for patients with discogenic low back pain. Methods The clinical data were collected in 120 patients treated with radiofrequen?cy and ozone for lumbar disc herniation at Tianjin Hospital from October 2013 to October 2015. Pain visual analogue scale (VAS) was used to patients at preoperative and postoperative 1 week, 1, 3, 6 and 12 months. Health survey (SF-36) score was used at preoperative and postoperative six months. The efficacy was evaluated by MacNab curative effect evaluation. Re?sults The preoperative VAS score was (7.02±0.64) points. The postoperative VAS scores were (3.13±0.32) points, (2.11± 0.67) points,(2.62±0.89) points,(2.37±0.34) points and (2.31±0.50) points at one week, one month, three months, six months and twelve months, respectively. The VAS scores were significantly decreased after surgery (P<0.05). Preoperative SF-36 score was (48.32 ± 7.46) points, which reached to the (82.03 ± 5.89) points six months after surgery (P < 0.05). After six months, the fineness rate reached to 89.17%evaluated by MacNab curative effect evaluation. Conclusion Radiofrequency combined with ozone treatment is an effective and reliable method for discogenic low back pain.

Optical postoperative analgesia can improve patient mobility, reduce the incidence of complications, and im-prove patient satisfaction, while reducing hospital stays and costs. Early postoperative analgesia mainly depends on the opioids. In recent years, multimodal analgesia (MMA) program has been developed rapidly, which can significantly reduce the use of opioids and related adverse reactions. MMA in spinal surgery mainly includes advanced analgesia, non-steroidal anti-inflammatory drugs, neuromodulation drugs, acetaminophen drugs, intrathecal block and local expanded anesthesia. Current studies show that selective non-steroidal anti-inflammatory drugs or short-term, low-dose non-selective non-steroidal anti-inflammatory drugs do not affect postoperative spinal fusion; Neuromodulators can alleviate pain and reduce opioid use, while without significant adverse effects; Acetaminophen is the basis for different analgesia regimens after spinal surgery; In addition, level I evidence suggests that intrathe-cal block after lumbar discectomy can improve short-term pain and neurological symptoms of patients; Some studies suggest that local expanded anesthesia can reduce the use of other analgesics after spinal surgery. A growing of evidence supports the use of ad-vanced MMA regimens to control postoperative pain in patients undergoing spinal surgery, but further high-quality studies are needed to determine the optimal agent, dose, and timing of the MMA regimen, and to further elucidate the impact on spinal surgery outcomes.

Objective To establish a three-dimensional finite element model of thoracolumbar fractures treated by mono-segmental instrumentation in the fractured part for testing effect of such fixation mode on adjacent segments.Methods CT scanning data of T10-L2 were used to build a normal model at T10-L2 region,a fracture model at T12 segment as well as a mono-segment fixation or short-segment fixation model.Stress of discs and vertebral body adjacent to the fixed vertebrae were tested in axial compression,anteflexion,extention,lateroflexion,and axial rotation.Results The fracture model presented significant increase concerning stress of nucleus pulposus and annular fibrosus at T10-T11 segments and annular fibrosus at L1-L2 segments in anteflexion,extention,and lateroflexion when compared with the normal model.General raise range of the stress reached around 75％,but was dropped to 23％ after short-segment fixation and to 18％ after mono-segmental fixation.And again,stress of nucleus pulposus at L1-L2 segments was increased by 46％ or so,which was declined to 12％ after short-segment fixation and to 8％ after mono-segmental fixation.Stress at lower endplate of T10 and at upper endplate of L2 in the fracture model group were increased by 24％ and 43％ respectively when compared to the normal model,but both presented a notable drop after internal fixation.The latter was decreased to a level slightly higher than that of model group,namely 8％ more after short-segmental fixation and 4％ more after mono-segmental fixation; the former was decreased to a level even lower than that of control group,namely 2％ less after short-segmental fixation and 8％ less after mono-segmental fixation.Conclusion Mono-segmental fixation reduces adjacent disc stress in contrast to conventional short-segmental fixation and hence is an effective alternative treatment of monosegmental thoracolumbar fractures.

Objective To evaluate the feasibility and clinical efficacy of microendoscopic discectomy-lumbar interbody fusion (MED-LIF) with mobile microendoscopic discectomy (MMED) technique. Methods The MMED includes outer working canal and inner operating canal, and large working canals (12 mm and 14 mm) are fabricated for this operation. The operation was designed as follow:an incision was made between pedicle projection sites and spinous process on the side with prominent symptom. Working canal was inserted along spinous process and a fenestration was performed. After discectomy and ipsilateral decompression, contralateral nerve was decompressed in case of contralateral stenosis. Then the intervertebral space was prepared and grafted. The inner operating canal was removed and the suitable cage was inserted, followed by percutaneous pedicles screws installation, reduction and fixation. A total of 102 patients with lumbar degenerative disc disease were treated by this technique. The index levels included L34 (n=11), L45 (n=64), L5S1 (n=21), L3-5 (n=3), and L4-S1(n=3). The operative data and follow-up results were recorded and evaluated. Results Surgery was successful in all patients, with no nerve injury or conversion to open surgery. The mean operative time was ( 120 ± 30) min (range, 90-200 min), with a mean blood loss of (120 ± 80) mL (range, 50-300 mL). The post-operative X-ray and CT scans showed improvement of spinal alignment with sufficient decompression. Patients were followed up for 6 to 36 months. The Oswestry disability index (ODI) score decreased from the pre-operative 44.2%±16.3%to the last follow-up 4.9%±4.7%. The visual analog pain score (VAS) of lumbar decreased from the pre-operative 5.3±4.1 to the last follow-up 2.1±1.7, and VAS of leg decreased from the pre-operative 6.7 ± 3.5 to 1.0 ± 0.8 at final follow-up. The clinical results were excellent in 46 cases, good in 50 cases and fair in 6 cases according to the Macnab standard. Conclusion MED-LIF can be easily performed with MMED technique, with sufficient decompression and reduction, providing satisfactory results with less invasive procedure.

Objective To evaluate the feasibility and clinical efficacy of microendoscopic discectomy-transforaminal lumbar interbody fusion (MED-TLIF) with mobile microendoscopic discectomy (MMED) technique. Methods The MMED includes outer working canal and inner operating canal. Large working canals and endoscopic chisel were fabricated for MMED-TLIF,which was designed as follow:the pedicles and index level were located with fluoroscopy, and a 2.5 cm incision was made between pedicle punctures sites on the symptomatic side. Working canal was inserted, and the facet was exposed,the inferior articular process and medial part of superior articular process were resected. The disc and cartilage endplates were curettage, and the intervertebral space was released and tested. The inner operating canal was removed and the interbody space was grafted and supported with suitable cage. Percutaneous pedicles screws were inserted and the residual displacement was evaluated under fluoroscopy, followed by the install of connecting rods for reduction and fixation. Fifty-six patients with lumbar stenosis including 32 cases of instability and spondylolisthesis (1 degree in 15 cases and 2 degree in 9 cases) were treated with this technique. The ODI index and VAS score were compared in patients before and after surgery. The efficacy was evaluated by Macnab standard. Results Surgery was successful in all patients, with no nerve injury or conversion to open surgery. The mean operative time was (120±30) min (range, 90–180 min),with a mean blood loss of (120±50) mL (range,50–200 mL). The post-operative X-ray and CT scans showed improvement of spinal alignment with mean reduction ratio of 72%. Patients were followed up for 6 to 36 months. The ODI score decreased from 50.1±11.2 to 5.8±5.6. The VAS score of lumbar decreased from 7.1±4.2 to 1.2±1.0 and VAS score of leg decreased from 4.1±2.5 to 1.1±0.9 at final follow-up. The clinical results were excellent in 36 cases,good in 20 according to the Macnab scale. Conclusion MED-TLIF can easily perform with MMED technique,with sufficient decompression and reduction, and providing satisfactory results with less invasive procedure.

Objective:To evaluate the value and efficacy of self-anchored anterior lumbar discectomy and fusion (SA-ALDF) for L 5 isthmic spondylolisthesis. Methods:From June 2018 to December 2019, a total of 11 cases of L 5 isthmic spondylolisthesis were treated with SA-ALDF, including 4 men and 7 women, aged 43.2±12.6 (range 29-63) years. All patients had intractable low back pain aggravating during standing activities and alleviating during rest, without lower extremity radicular symptoms. Imaging examination showed bilateral isthmus cleft of L 5 with spondylolisthesis of 1 degree in 10 cases and 2 degree in 1 case according to Meyerding grading system. Under general anesthesia and supine French position, transverse 6 cm incision was made. Then, the L 5S 1 intervertebral disc was exposed via extraperitoneal approach between the bifurcation of abdominal aorta and vena cava. The intervertebral disc was sufficiently removed. The intervertebral space was released and distracted followed by canal ventral decompression and sequential mold testing. Suitable self-anchoring cage filled with auto iliac cancellous bone was implanted to restore intervertebral height and lordosis as well as reduction of spondylolisthesis. Under fluoroscopic guidance, the distal anchoring plate was knocked into the sacrum followed by direct reduction and proximal anchoring plate locking in the L 5 vertebral body. The patients were followed up for 12.1±4.7 (range 6-18) months. The visual analogue score (VAS) and Oswestry dysfunction index (ODI) were evaluated. The reduction and fusion were evaluated on the X-ray films. Furthermore, the rate of spondylolisthesis, the height and the lordosis of intervertebral space were measured. Results:The operation was performed successfully in all the patients with operation duration 90±18 (range 70-120) min, intraoperative blood loss 30±16 (range 10-60) ml. No severe complication such as nerve and blood vessel injury occurred. All patients experienced alleviation of symptom during follow-up. X-rays confirmed that the spondylolisthesis and alignment were recovered obviously without obvious cage displacement. However, the loss of reduction was 63.2% for the grade 2 spondylolisthesis. At the final follow-up, VAS decreased from 6.1±2.1 to 0.9±0.5, ODI decreased from 43.6%±14.2% to 6.0%±3.4%. The spondylolisthesis recovered from 17.7%±10.3% to 8.0%±7.2% with reduction rate of 54.8%±21.6%. The interverbral height recovered from 6.4±2.1 mm to 9.8±3.9 mm and intervertebral lordosis recovered from 4.8°±2.9° to 9.6°±4.7°.Conclusion:SA-ALDF can provide satisfactory outcomes for selected L 5 isthmic spondylolisthesis of degree 1 without neurological compromise. However, its mechanical stability may be insufficient for isthmic spondylolisthesis of degree 2.

Objective To provide a minimally invasive surgical treatment using mobile microendoscopy (mobile MED) for limited cervical spine canal stenosis. Methods Eleven patients were collected from February 2015 to February 2016 in Tianjin Hospital, including 6 males and 5 females, aged 51- 77 years, mean (67.4 ± 7.6) years. Clinical treatment was performed on 11 patients of limited cervical spinal stenosis. The levels of stenosis included C3-5 in 5 cases, C4-6 in 4 cases, C5-7 in 2 cases. The working channel of mobile MED (MMED) can be tilted according to the need of operation. The design of surgical methods:the levels of stenosis were located with fluroscopy, through a posterior median 2.5 cm incision, the nachal ligaments was separated and the spinous process was reached. After a little dissection of paraspinal mascle, the working canal was inserted along the spinous process, and the target lamina was exposed. With MMED, the partial laminectomy was performed along the junction groove of lamina and articular process with high-speed burr, and flavum was exposed and resected with ultra-thin Kerisson, and the dural sac was well exposed. Then the working canal was inserted on the contralateral side along the spinous process, and the decompression was performed with the same method. After bilateral direct decompression, the spinous process and posterior ligament complex shift posteriorly with enlargement of spinal canal. The operation time and blood loss were recorded and the efficacy was followed-up. Results There was no serious complications such as neurological injury. The operation time ranged 80-120 min, with an average of (100 ± 18) min. The intraoperative blood loss ranged (50-120) mL, with an average of (80 ± 20) mL. Postoperative CT showed sufficient decompression and enlargement of the canal with the posterior shift of the spinous process and posterior ligament complex. The patients were followed up for 6-18 months. The alignment of cervical spine was well preserved on X-ray. The ODI decreased from 42.2 ± 16.3 preoperatively to 6.2 ± 4.3. The JOA score improved from 8.2 ± 3.3 preoperatively to 15.1 ± 4.2 at the last follow-up. According to the improvement rate [(JOA-preoperative JOA)/(17-preoperative JOA)], the results were excellent in 5 cases, good in 5 cases, and effective in 1 case. Conclusion The cervical canal enlargement with mobile microendoscopic discectomy technique preserving posterior ligament composite provides a minimally invasive procedure for limited cervical stenosis with adequate decompression.