Objective To evaluate the efficacy of combined anterior and posterior approaches in treatment of severely unstable lower lumbar burst fractures.Methods A retrospective case series study was made on clinical data of 14 patients with lower lumbar burst fractures collected from August 2009 to August 2014.There were 12 males and 2 females,with a mean age of 39 years.Seven fractures occurred at L3,five at L4,and two at L5.Nine patients were associated with injury to the posterior ligament complex (PLC).According to the American Spinal Injury Association (ASIA) classification,the spinal injuries were rated as grade B in two patients,grade C in four,grade D in five and grade E in three.All patients underwent posterior pedicle screw fixation combined with anterior spinal canal decompression and titanium mesh or iliac bone grafting.Lumbar lordosis angle,vertebral height,spinal canal decompression,ASIA grade and complications were evaluated after operation.Results Two patients experienced cerebrospinal fluid leakage postoperatively,which were healed after 2 weeks' local pressure treatment.Three patients experienced recurrent lumbar pain postoperatively,which were relieved after the removal of internal fixation 18 months after operation.All patients were followed up for 12-36 months (mean,18 months).Compared to the detection before operation,final follow-up showed improved lumbar lordosis [(30.2 ± 7.3) ° vs.(41.3 ± 6.5) °],decreased loss of the anterior vertebral height [(62.3 ± 21.5) ％ vs.(11.8 ± 7.8) ％] and reduced canal compromise [(65.7 ± 30.5) ％ vs.(21.9 ± 12.7)％] (all P ＜ 0.05).ASIA grade was significantly improved at the final follow-up,including grade C in one patient,grade D in three and grade E in ten (P ＜ 0.05).Follow-up showed no apparent graft loosening,pseudarthrosis,implant breakage and severe kyphosis.Conclusion Combined anterior and posterior approaches to treat severely unstable lower lumbar burst fractures can effectively reconstruct the height and stability of the vertebral body,restore the spinal canal volume,and attain satisfactory clinical outcome.

Objective To compare the outcomes of percutaneous pedicle instrumentation combined with vertebral augmentation or vertebra pedicle instrumentation for treatment of osteoporotic thoracolumbar fractures (OVCF) in elderly patients.Methods A retrospective case cohort study was conducted on 62 patients with OVCF manifesting non-neurological symptoms treated from January 2009 to January 2012.There were 22 males and 30 females,with a mean age of 61.3 years (range,55 to 70 years).Fracture level was T11 in 8 patients,T12in 20,L1 in 22 and L2 in 12.Treatments included percutaneous pedicle instrumentation combined with vertebral fracture fixation in 36 patients (Group A) and percutaneous pedicle instrumentation combined with vertebral augmentation in 26 patients (Group B).Operation time,intraoperative blood loss,anterior vertebral body height,sagittal Cobb angle and visual analogue score (VAS) were compared between the two groups.Results All patients were followed up for average 46.5 months (range,36 to 58 months).Operation time in Group A [(82.6 ±16.2) min] was shorter than that in Group B [(96.8 ± 20.6) min] (P ＜ 0.05).Blood loss in Group B [(40.5 ± 10.2) ml] was less than that in Group A [(52.2 ± 15.5) ml] (P ＜ 0.05).Before operation and 3 days and 1 year after operation,the anterior vertebral body height and sagittal Cobb angle in Group A showed no significant differences compared to Group B (all P ＞ 0.05).At the final follow-up,the ratio of anterior vertebral height and Cobb angle in Group B [(87.8 ± 2.5) ％,(7.8 ± 3.5) °] were better than these in Group A [(82.6 ±3.2)％,(9.1 ± 1.8)°] (P＜0.05).VAS showed no statistical significance between the two groups before and after operation (P ＞ 0.05).Bone cement leakage was seen in four patients in Group B.During the perioperative period,there were 3 patients with lung infection in Group A and 1 patient with lower limb deep vein thrombosis in Group B.No implant failure occurred in both groups.Conclusion Both procedures are effective in treating elderly patients with OVCF,but percutaneous pedicle instrumentation combined with vertebral augmentation is associated with better results in maintaining vertebral height and preventing kyphosis.

AIM:To investigate the effect of AG 490 on the expression of VEGF and HIF-1α, and the capacity of invasion in human erythroleukemia (HEL) cells.METHODS:The HEL cells were treated with AG490 at different con-centrations .The cell viability was detected by CCK-8 assay.The apoptosis was detected by Hoechst staining .The apoptosis and the cell cycle were analyzed by flow cytometry .The capacity of migration was evaluated by Transwell assay .The mRNA expression level of JAK2 was measured by RT-PCR.The protein levels of p-JAK2, VEGF and HIF-1αwere determined by Western blot.RESULTS:The HEL cell viabilities were 88%, 75%, 48%, 10%and 0.12%after treated with AG490 at 20, 40, 60, 80 and 100 μmol/L for 48 h, respectively.The results of Hoechst staining showed that brilliant blue cells in 80 μmol/L AG490 group was significantly increased compared with control group for 48 h.The apoptosis rate of 80μmol/L AG490 group was significantly increased compared with control group at 48 h after AG490 treatment.The number of membrane-permeating HEL cells in 20μmol/L AG490 group at 24 h after AG490 treatment was significantly lower than that in control group (P<0.05).The mRNA level of JAK2 decreased in a concentration-dependent manner after the HEL cells were treated with different concentrations of AG 490 for 48 h.The protein levels of p-JAK2, VEGF and HIF-1αwere lower in AG490 treatment groups than those in control group (P<0.05).CONCLUSION: AG490 inhibits the expression of VEGF and HIF-1αin HEL cells by inhibiting JAK2 pathway.

Objective To evaluate the efficacy of pedicle subtraction osteotomy (PSO) plus long-segment pedicle nail bar system in treating kyphosis in ankylosing spondylitis (AS) combined with thoracolumbar fractures.Methods A retrospective case series study was made on the clinical data of 13 patients with kyphosis in AS combined with thoracolumbar fractures admitted to Xiaoshan Hospital of Traditional Chinese Medicine from January 2012 to May 2016.There were 11 males and two females,aged 32-64 years [(44.3 ± 10.6) years].Two fractures occurred at T11,five at T12,three at L1,and three at L2.According to the American Spinal Injury Association (ASIA) classification,the spinal injuries were rated as grade B in one patient,grade C in four,grade D in five and grade E in three.All patients underwent PSO plus long-segment pedicle nail bar system.The operation duration,intraoperative blood loss,fixation segments,and complications were recorded.Thoracolumbar kyphosis angle (TL) and sagittal vertical axis (SVA) were measured to evalute the correction effect.Visual analogue scale (VAS),Oswestry disability index (ODI),ASIA grade were compared before and after operation to assess the efficacy.Results All patients were followed up for 12-18 months [(15.2 ± 1.2) months].The operation time ranged from 120 to 256 minutes [(175.2 ±40.3)minutes].The intraoperative blood loss ranged from 660 to 3 300 ml [(1 011 ±681)ml].Number of fixed seqments was 12-16 (12.2 ±0.8).Anemia occurred in one patient after operation,and the patient recovered after blood transfusion.Incision infection occurred in one patient after operation,which was improved after antibiotic treatment through osmotic culture.Compared with the detection before operation,postoperative TL was improved significantly [(52.6 ± 6.2) ° vs.(17.1 ± 3.1) °],with an average correction rate of 67.5％;final follow-up showed decreased VAS [(7.5 ± 0.7) points vs.(1.9 ± 0.6) points] and decreased ODI [(75.2 ±5.3) points vs.(22.9 ± 4.4) points] (P ＜ 0.05);SVA was improved significantly [(11.5 ± 2.1) cm vs.(3.5 ± 0.9) cm],with an average correction rate of 69.6％ (P ＜ 0.05).ASIA grade was significantly improved at the final follow-up,including grade D in three patients and grade E in ten patients (P ＜0.05).There was no case of epidural hematoma or infection after operation,and no loosening of internal fixator or pseudarthrosis formation occurred during follow-up.Conclusion For kyphosis in AS combined with thoracolumbar fractures,PSO osteotomy plus long segment pedicle nail bar system treatment can significantly reduce lower back pain and promote functional recovery.

Objective:To study the impact of repeat hepatectomy for patients with post-hepatectomy recurrent hepatocellular carcinoma (HCC).Methods:The data of patients who developed post-hepatecotmy recurrent HCC and underwent repeat hepatectomy at the General Surgery Department of Beijing Tongren Hospital from May 2013 to May 2016 (the Recurrence Group), were retrospectively compared with the data from patients who underwent initial hepatectomy for HCC during the same study period (the Primary Group). The general data, perioperative data, postoperative complications and survival of the two groups were compared.Results:The primary group included 179 patients, consisting of 133 males and 46 females, aged (57.3±11.7) years, with a range from 14.0 to 84.0 years. The recurrence group included 36 patients, consisting of 30 males and 6 females, aged (55.9±11.4) years, with a range from 40.0 to 77.0 years. There were no statistically significant differences between the two groups in gender, age, hepatitis virus infection status, preoperative alpha fetoprotein, Child-Pugh score and indocyanine green retention rate at 15 min ( P>0.05). However, there were statistically significant differences ( P<0.05) between the two groups in operative time [(244.2±84.3)min vs. (283.4±66.8)min], intraoperative blood loss[(428.5±151.6)ml vs. (756.2±187.4)ml], anatomic or nonanatomic hepatectomy, single tumor or multiple tumors, and maximum tumor diameter[(5.81±2.24)cm vs. (3.69±1.55)cm]. There were no statistically significant differences between the two groups in incidences of tumor capsular invasion, tumor thrombus and degrees of tumor differentiation ( P>0.05). There were no statistically significant differences in surgical complication rates ( P>0.05), and in 1-year and 3-year overall and disease free survival rates between the two groups ( P>0.05). Conclusions:Repeat hepatectomy for recurrent HCC after hepatectomy was safe and effective. Its long-term survival outcomes were similar to first hepatectomy for HCC.

Objective:To compare the clinical efficacy of pedicle subtraction osteotomy (PSO) versus vertebroplasty (VP) combined with long segment fixation for nonunion of osteoporotic vertebral fractures with kyphosis.Methods:A retrospective cohort study was conducted to analyze the clinical data of 72 patients with nonunion of osteoporotic vertebral fractures with kyphosis admitted to Jiangnan Hospital affiliated to Zhejiang University of Traditional Chinese Medicine from January 2010 to December 2017. There were 16 males and 56 females, aged 55-84 years [(68.2±5.2)years]. Level of injury was located at T 11 in 3 patients, at T 12 in 19, at L 1 in 31, and at L 2 in 19. According to the American Spinal Injury Association (ASIA) classification, 31 patients were scaled as grade D and 41 grade E. Overall, 51 patients were treated with PSO combined with long segment fixation (PSO group) and 21 patients treated with VP combined with long segment fixation (VP group). The operation time and bleeding volume were compared between the two groups. Before operation, at postoperative 2 weeks and at the last follow-up, the kyphotic Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK) and lumbar kyphosis (LL) were used to evaluate the osteotomy effect, and the visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the degree of pain and lumbar function recovery. The improvement of ASIA grade was observed at the last follow-up. The complications were observed as well. Results:All patients were followed up for 24-46 months [(33.2±5.9)months].The operation time and bleeding volume were more in PSO group than in VP group (all P<0.01). Before operation, the kyphotic Cobb angle, SVA, TK and LL were not significantly different between the two groups (all P>0.05). At postoperative 2 weeks, TK was not significantly different between the two groups ( P>0.05), while PSO group showed significantly decrease of kyphotic Cobb angle and SVA and increase of LL when compared with VP group ( P<0.05 or 0.01). At the last follow-up, the kyphotic Cobb angle, SVA and TK in PSO group were (8.5±1.1)°, (2.6±0.5)cm and (28.8±6.2)°, respectively, significant lower than those in VP group [(14.2±1.5)°, (4.4±0.9)cm and (32.6±5.9)°] (all P<0.05); while the LL was significantly larger in PSO group [(43.1±3.9)°] than in VP group [(36.9±5.3)°] ( P<0.01). Before operation, the VAS and ODI were not significantly different between the two groups (all P>0.05). At postoperative 2 weeks, the VAS and ODI in the two groups were also not significantly different (all P>0.05), but both were greatly decreased from the preoperative level (all P<0.05). At the last follow-up, the VAS and ODI in PSO group were (1.4±0.5)points and 22.5±2.5, significant higher than (1.8±0.6)points and 25.5±5.1 in VP group (all P<0.01). At the last follow-up, the ASIA classification was grade E in all patients. There were 1 patient suffering from dural matter tear and 1 from proximal junctional kyphosis in PSO group. Whereas 3 patients had bone cement leaking and 1 pedicle screw loosening in PVP group. The complication rate was 3.9% (2/51) in PSO group, significant lower than 19.0%(4/21) in VP group ( P<0.05). Conclusion:Compared with VP group in the treatment of osteoporotic vertebral fractures with kyphosis, PSO combined with long segment fixation is much effective in improving kyphosis angle and spinal axial imbalance correction, maintaining vertebral height and spinal axial stability in middle- to long-term, improving pain and dysfunction and minimizing complications, regardless of more operation time and bleeding volume.