Objective To investigate the clinical effect of 3D printing assisted percutaneous vertebroplasty (PVP) in treating severe osteoporotic vertebral compression fracture (OVCF) in elder patients.Methods A retrospective case series study was conducted on the clinical data of 58 elderly patients (58 vertebrae) with severe OVCF who underwent PVP treatment in spinal surgery department of Henan Provincial People's Hospital from June 2014 to June 2016.According to the treatment method,the patients were divided into Group A which adopted 3D printing of injured vertebrae before PVP and Group B which adopted routine PVP operation.Group A consisted of 28 cases (28 vertebrae),including eight males and 20 females,aged 64-91 years [(78.1 ±8.5) years].In terms of the distribution of injured vertebrae,there were four cases of T10,six cases of Tu,eight cases of T12,four cases of L1,and six cases of L2 in Group A.Group B consisted of 30 cases (30 vertebrae),including 10 males and 20 females,aged 65-90 years [(77.8 ± 8.2) years].In terms of the distribution of injured vertebrae,there were three cases of T10,seven T11,nine T12,six L1,and five L2.The operation time,visual analogue scale (VAS) before operation,1 day after operation and at the last follow up,Japanese Orthopedic Association (JOA) score,anterior compression ratio of injured vertebrae,and cement leakage rate were compared between the two groups.Results All the operations were completed successfully.The patients were followed up for 14-26 months [(18.7 ± 3.4)months] in Group A and for 12-28 months [(20.0 ± 5.4) months] in Group B.The operation time was (28.0 ± 3.4) min in Group A and (30.9 ±5.3) min in Group B (P ＜ 0.05).Both the VAS 1 d after operation of Group A [(2.3 ± 1.0) points] and Group B [(2.0 ± 0.8) points] and the VAS at the last follow up of Group A [(0.7 ± 0.7) points] and Group B [(0.8 ± 0.7) points] were significantly lower than those before operation (P ＜ 0.05),but there was no significant difference between thetwo groups (P ＞ 0.05).Both the JOA at day 1 after operation of Group A [(21.3 ± 2.2) points] and Group B [(20.7 ± 2.1) points] and the JOA at the last follow up of Group A [(24.7 ± 2.3) points] and Group B [(24.1 ± 2.0) points] were significantly higher than those before operation (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).The anterior compression ratio of injured vertebrae 1 d after operation of Group A (59.4 ± 7.9) ％ and Group B (59.1 ± 6.8) ％ and that at the last follow up of Group A (59.1 ± 7.8) ％ and Group B (58.7 ± 5.4) ％ were significantly improved than those before operation (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).There were three cases of bone cement leakage in Group A (11％) and 11 cases of bone cement leakage in Group B (37％) after PVP,and the difference was statistically significant (P ＜ 0.05).Conclusion Compared with conventional PVP,3D printingassisted PVP has lower leakage rate,shorter operation time,and better clinical effect in treating severe OVCF in the elderly.

Objective To evaluate the efficacy of modified posterior unilateral subtotal corpectomy osteotomy correction for old thoracolumbar vertebral fractures combined with kyphosis. Methods A retrospective case series study was conducted to analyze 18 patients with old thoracolumbar vertebral fractures combined with kyphosis admitted to the Henan Provincial People's Hospital from January 2012 to October 2016. There were 10 males and eight females, aged 25-70 years, with an average age of 38. 2 years. The injured segments and osteotomy segments included T11 in one patient, T12 in four, L1 in six, and L2 in seven. Five patients had neurological impairment symptoms classified as grade D according to Frankel's classification. All patients underwent the modified posterior unilateral subtotal corpectomy osteotomy correction. The operation time and intraoperative blood loss were recorded. The visual analogue score (VAS), Oswestry dysfunction index (ODI) and kyphosis Cobb angle were compared before operation, half a year after operation and at the last follow-up. The osteotomy fusion was evaluated by Suk criterion and Frankel grading was used to evaluate the recovery of nerve function. The complications were also recorded. Results All patients were followed up for 12-24 months, with an average of 17. 6 months. The operation time was 160-285 minutes [(190. 0 ± 42. 6) minutes, and the intraoperative blood loss was 500-800 ml [(610. 0 ± 134. 3) ml]. The difference of kyphosis Cobb angle between preoperative [(40.5±9.8)°] and [(5.5 ±1.6)°] at 6 months postoperatively had statistical significance (P <0. 05). Compared with the kyphosis Cobb angle of 6 months postoperatively [(5. 5 ± 1. 6)°], the Cobb angle at the final follow-up [(6. 2 ± 1. 5)°] did not change significantly (P>0. 05). The VAS score and ODI at 6 months after operation and at the final follow-up [(3. 1 ± 1. 3)points,(2. 7 ± 0. 7)points and 7. 5 ± 5. 1, 6. 4 ± 2. 5] were significantly different compared with those before operation [(7. 6 ± 2. 4)points, 68. 7 ± 10. 4] (P<0. 05). Bone cutting surface was healed osseously in all patients. The five patients with preoperative neurological impairment of grade D were assigned with grade E at the last follow up. There were two patients with dural rupture and one with pleural effusion during the operation. No complications such as nerve damage, infection or thrombosis occurred. No loosening, fracture or heterotopic ossification occurred during follow-up. Conclusion For old thoracolumbar vertebral fracture combined with kyphosis, the modified posterior unilateral vertebral column resection through unilateral approach can not only achieve the bone fusion between the injured vertebra and the adjacent vertebral body, but also avoid the shortening of the spine, correcting kyphosis and relieving pain, with low incidence of complications.

Objective To investigate the correlation between the changes of fat and microcirculation in vertebral marrow and the intervertebral disc degeneration. Methods This was a cross-sectional cohort study. Based on the inclusion and exclusion criteria, all 82 patients were recruited, while 246 lumbar intervertebral disc (L2/3-L4/5) were studied. Each disc was assessed by using Pfirrmann grades. The chemical shift imaging (CSI) was performed to calculate the signal intensity ratio (SIR) of the corresponding upper and under vertebral marrow. And intravoxel incoherent motion (IVIM) imaging was performed to obtain the IVIM parameters of slow apparent diffusion coefficient (Dslow), fast apparent diffusion coefficient (Dfast) and perfusion fraction (f). At the same time, b values of 0, 600 s/mm2 were used to obtain the ADC value of each disc. The ADC values of disc, the SIR values and IVIM parameters of the upper and under vertebral marrow between the different segments and different Pfirrmann grading groups were compared using one-way ANOVA or non-parametric test. The correlation of the Pfirrmann grading and ADC value of disc with the parameters of the vertebral marrow were analyzed, respectively. Results Only the f value of the upper and under vertebral marrow showed significant difference between the different segments groups of L2/3 to L4/5 discs (F=5.351 and 8.482, both P<0.05). The ADC values of discs, the SIR value of the upper vertebral marrow and the Dslow value of the under vertebral marrow had significant difference between the different Pfirrmann grading groups (all P<0.05). The Pfirrmann grading was negatively correlated with the disc ADC values (r=-0.651, P<0.01), and was mildly and positively correlated with the SIR values of the upper and under vertebral marrow (r=0.238 and 0.266, both P<0.01). The disc ADC values had a slightly negative correlation with the SIR value of the upper and under vertebral marrow(r=-0.230 and-0.247, both P<0.01). Conclusions The changes of the SIR value and all IVIM parameters of the vertebral bone marrow were not very obvious with the increasing of the grading of the intervertebral disc degeneration, which may be not an effective supplement for the grading of intervertebral disc degeneration.

Objective To investigate the correlation between the changes of fat and microcirculation in vertebral marrow and the intervertebral disc degeneration. Methods This was a cross-sectional cohort study. Based on the inclusion and exclusion criteria, all 82 patients were recruited, while 246 lumbar intervertebral disc (L2/3-L4/5) were studied. Each disc was assessed by using Pfirrmann grades. The chemical shift imaging (CSI) was performed to calculate the signal intensity ratio (SIR) of the corresponding upper and under vertebral marrow. And intravoxel incoherent motion (IVIM) imaging was performed to obtain the IVIM parameters of slow apparent diffusion coefficient (Dslow), fast apparent diffusion coefficient (Dfast) and perfusion fraction (f). At the same time, b values of 0, 600 s/mm2 were used to obtain the ADC value of each disc. The ADC values of disc, the SIR values and IVIM parameters of the upper and under vertebral marrow between the different segments and different Pfirrmann grading groups were compared using one-way ANOVA or non-parametric test. The correlation of the Pfirrmann grading and ADC value of disc with the parameters of the vertebral marrow were analyzed, respectively. Results Only the f value of the upper and under vertebral marrow showed significant difference between the different segments groups of L2/3 to L4/5 discs (F=5.351 and 8.482, both P<0.05). The ADC values of discs, the SIR value of the upper vertebral marrow and the Dslow value of the under vertebral marrow had significant difference between the different Pfirrmann grading groups (all P<0.05). The Pfirrmann grading was negatively correlated with the disc ADC values (r=-0.651, P<0.01), and was mildly and positively correlated with the SIR values of the upper and under vertebral marrow (r=0.238 and 0.266, both P<0.01). The disc ADC values had a slightly negative correlation with the SIR value of the upper and under vertebral marrow(r=-0.230 and-0.247, both P<0.01). Conclusions The changes of the SIR value and all IVIM parameters of the vertebral bone marrow were not very obvious with the increasing of the grading of the intervertebral disc degeneration, which may be not an effective supplement for the grading of intervertebral disc degeneration.

Objective To assess the clinical value of lung ultrasound (LUS) B-lines in diagnosis of rheumatoid arthritis (RA) associated interstitial lung diseases (RA-ILD).Methods Forty-five consecutive patients with RA who underwent a high resolution computed tomography (HRCT) scan of the chest,were also examined by LUS for detection of B-lines(within 1 month independently in all patients).The B-lines score was obtained by summing the number of total 50 inter-costal spaces (ICSs) of chest wall.Pulmonary fibrosis was quantified by HRCT as previously described by the 30-point Warrick score.Results B-lines score significantly correlated with the Warrick score [(r=0.778,95％CI(0.627,0.872),P＜0.05].Receiver operating characteristic (ROC) curve confirmed that B-lines cut-off point 77[sensitivity of 100％,specificity of 64.3％ respectively,area under curve [AUC] =0.86,95％CI(0.724,0.945)] and 108[sensitivity of 90％,specificity of 88.6％ respectively,AUC=0.879,95％CI(0.747,0.957)] had an optimal power to discriminate mild (Warrick score＜8) and severe fibrosis (Warrick score＞15):Conclusion The data confirm that LUS is a useful technique to identify ILD in RA.In RA-ILD,B-lines correlate significantly with HRCT and are able to identify mild and severe degree of fibrosis.LUS is a promising non-invasive and non-ionizing strategy for screening RA-ILD.

Objective To investigate the clinical efficacy of percutaneous vertebroplasty (PVP) with bone filling container (BFC) and percutaneous kyphoplasty (PKP) by unilateral puncture approach in the treatment of osteoporotic vertebral compression fractures.Methods A retrospective case control study was conducted on 65 patients (65 vertebral bodies) with osteoporotic vertebral compression fractures (OVCF) who received PVP from March 2015 to March 2017 in Henan Provincial People's Hospital.There were 21 males and 44 females,aged 60-91 years,with an average of 76.2 years.The patients were divided into PVP with BFC group (BFC group) and PKP group treated by unilateral puncture approach.There were 10 males and 23 females in BFC group,with an average age of 75.8 years (range,60-91 years).The injured segments were distributed at T10 in seven patients,T11 in nine,T12 in eight,L1 in five,and L2 in four patients.There were 11 males and 21 females in PKP group,with an average age of 76.7 years (range,60-88 years).The injured segments were distributed at T10 in five patients,T11 in seven,T12 in ten,L1 in eight,and L2 in two patients.The operation time,cement leakage,as well as pain visual analogue score (VAS),modified Oswestry dysfunction index (ODI) and the Cobb angle of the fractured vertebral body at 3 days after operation and 12 months after operation were recorded and compared.Results All operations were completed successfully,without serious complications.The patients were followed up for 16-29 months [(21.2 ± 4.5) months] in BFC group and 15-32 months [(23.8 ± 6.2) months] in PKP group.The operation time was (27.8 ± 3.6) minutes in BFC group and (31.0 ± 5.2) minutes in PKP group (P ＜ 0.05).Postoperative X-ray and CT showed that bone cements leakage occurred in three patients of BFC group (9％) and in ten patients of PKP group (31％) (P ＜0.05).The VAS at 3 days after operation in BFC group and PKP group was (2.3 ± 1.0) points and (2.1 ±0.8)points respectively.The VAS at 12 months after operation in BFC group and PKP group was (0.7 ± 0.7) points and (O.8 ± 0.7) points respectively.The postoperative VAS was significantly decreased compared with the preoperative VAS (P ＜0.05),but there was no significant difference between the two groups (P ＞ 0.05).The modified ODI at 3 days after operation in BFC group and PKP group were (31.5 ± 4.7) ％ and (30.4 ± 5.7) ％,respectively.The modified ODI at 12 months after operation in BFC group and PKP group was (16.7 ±4.9)％ and (15.1 ±5.6)％,respectively.The postoperative ODI were significantly decreased compared with the preoperative ODI(P ＜0.05),but there was no significant difference between the two groups (P ＞ 0.05).The Cobb angle of the fractured vertebral body at 3 days after operation in BFC group and PKP group was (9.2 ± 3.0) ° and (10.0 ±2.9)°,respectively.The Cobb angle of the fractured vertebral body at 12 months after operation was (9.6 ± 2.8)° and (10.3 ± 3.0)°respectively.The postoperative Cobb angle was significantly decreased compared with the preoperative Cobb angle (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).Conclusions For OVCF,PVP with BFC by unilateral puncture approach can shorten the operation time and reduce the leakage rate of bone cement.It has similar effects with PKP in pain relief,function improvement of daily life and the correction of fracture vertebral kyphosis.

OBJECTIVETo investigate the safety and feasibility of laparoscopic radical right hemicolectomy using caudal-to-cranial approach (yellow-white borderline between right mesostenium and retroperitoneal is firstly cut as the entry to dissect the fusion fascial space between the visceral and parietal peritoneum, which is called caudal-to-cranial approach for right hemicolectomy).

METHODSFrom January 2014 to May 2015, 76 consecutive patients with right side colon cancer underwent laparoscopic radical right hemicolectomy using caudal-to-cranial approach. The baseline characteristics, intraoperative and postoperative outcomes were prospective collected and reviewed retrospectively.

RESULTSAll the 76 patients completed operations successfully, and one patient (1.3%) was converted to open surgery because of intraoperative bleeding due to unexpected injury of ileocolic artery. The mean operative time was (152.8±42.1) min with a mean estimated blood loss of (70.4±43.5) ml. The mean time of first flatus was (49.3±22.9) h and mean liquid oral intake was (58.5±17.6) h. The postoperative complications appeared in 7 patients (9.2%), including one (1.3%) of pulmonary infection, one(1.3%) of urinary system infection, two (2.6%) of wound infection, two (2.6%) of inflammatory bowel obstruction and one (1.3%) of lymphatic fistula, and they were all cured with conservative treatments. The postoperative hospital stay was (7.8±5.4) d. The mean number of harvested lymph node was 34.2±10.9, among which 4.1±2.8 was positive.

CONCLUSIONSLaparoscopic radical right hemicolectomy using caudal-to-cranial approach is safe and feasible.

Objective To evaluate the pathological stage,the presence of detrusor muscle and the clinical significance for standardized examination of specimens for en bloc transurethral resection technique with Hybrid Knife to treat NMIBC (ERBT) compared with conventional TURBT.Methods This was prospective randomized controlled study.This study was approved by the Ethics Committee of Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology (TJ-IRB20180604),and patients all signed informed consent.The clinical study registration number of this study:NCT03221062.The margin of the tumor was recognized and marked by with Hybrid Knife (0.5 cm away from the normal mucosa).Then water was injected into the submucosa and form a water pad,with a circular cutting layer by layer (0.5 cm away from the marked position),reaching the detrusor muscle in depth.After complete resection,the tumor was removed by specimen bag.Specimens for ERBT cohort were given standard handling.Resected specimen of ERBT stretched with pins on foam and its margin was stained.The basement of specimen was also stained.Total specimen sectioned into appropriate pieces for histological assessment in the department of pathology.TURBT cohort performed traditional surgical methods and pathological examination.All patients received postoperative intravesical instillation according to their pathology.Imaging and cystoscopy were performed every 3 months.The primary study end-point was the quality of resection,including the pathological stage and the presence of DM.Secondary outcomes were:short-term tumour recurrence rate (18 month),feasibility,and safety.Results From January 2017 to October 2017,109 patients were enrolled.51 patients underwent ERBT,and 58 patients underwent TURBT.The clinical characteristics of the patients in each cohort,such as average age,gender,average BMI,smoking history,the mean number of lesions and tumour size had no significant differences (P ＞ 0.05).The operation of 109 cases was completed successfully.There was no statistical difference between the operative time and the postoperative bladder irrigation time.Major intraoperative or postoperative complications (Clavien ≥ Ⅱ) did not occur in all of the patients.The percentage of T1 staging was higher in the ERBT cohort vs.TURBT cohort [21/51 (41.2％) vs.13/58 (22.4％),P =0.035],of which ERBT cohort accurately detected 9 cases (42.8％) of T1b patients,significantly higher than TURBT cohort (2 cases,15.4％) (P =0.096).All the ERBT samples showed the presence of DM (100.0％),while there was only 77.4％ in TURBT cohort (P ＜ 0.05).Mean follow-up (20.3 ± 3.1) months (ranged from 18 to 24 months).Recurrence rate were 8.9％ (4/45) in ERBT cohort vs.22.2％ (12/54) in TURBT cohort (P=0.059).Conclusions ERBT with Hybrid Knife for treatment NMIBC is a safe,effective,and provides high-quality specimens compared to TURBT.More high-risk NMIBC patients,especially T1 b patients,can be detected obviously by pathologist with the standardized treatment of specimens.

BACKGROUND:Fluid shear stress plays an important role in osteoblast proliferation and apoptosis.However,whether Caveolin-1 is involved in the process of fluid shear stress-induced proliferation and apoptosis in osteoblasts is unknown. OBJECTIVE:To explore the role of Caveolin-1 in fluid shear stress-regulated osteoblast proliferation and apoptosis. METHODS:The MC3T3-E1 osteoblasts in good growth status were selected and loaded with fluid shear stress at an intensity of 1.2 Pa for different times(0,30,60,90 minutes).The expression of Caveolin-1 protein was observed and conditions with a time of 60 minutes were screened for the experiment.MC3T3-E1 cells were divided into control group,fluid shear stress group,fluid shear stress+pcDNA 3.1 group(control),fluid shear stress+pcDNA Cav-1 group(plasmid overexpression),and intervened with fluid shear stress and overexpression of Cav-1,respectively.The expression of molecules related to proliferation and apoptosis in MC3T3-E1 cells was detected by qRT-PCR and western blot.In addition,the proliferative activity of MC3T3-E1 cells was detected by cell counting kit-8 and EdU assay;and cell apoptosis was detected by Hoechst 33258 and flow cytometry. RESULTS AND CONCLUSION:The expression of Caveolin-1 in MC3T3-E1 cells was significantly down-regulated after loading fluid shear stress,and the expression level was lowest after 60 minutes.Overexpression of Caveolin-1 attenuated the proliferation-promoting and apoptosis-suppressing effects of fluid shear stress in MC3T3-E1 cells.In conclusion,Caveolin-1 has a vital role in fluid shear stress-regulated osteoblast proliferation and apoptosis,which may offer a potential therapeutic strategy for osteoporosis.