Osteoarthritis(OA) is a chronic progressive disease in the elderly, there are still no effective therapy for this disease. The objective of this article was to review progress in the clinical studies and therapies on the disease, especially NSAID therapy and total knee replacement.

Objective:To assess the relative stability and kinematics of the lumbar intervertebral segmental stiffness among posterior lumbar interbody fusion(PLIF) using one anatomical posterolateral cage with or without transpedicular screw rod fixation. Methods: Each of the 6 bovine lumbar functional spinal units(FSV) was tested under 6 different treatments. Test order was intact and every group differed in internal fixation of transpedicular screw. Group 1 referred to the normal lumbar functional spinal units. Group 2 was treated by left unilateral facetectomy and discoidectomy. Group 3 had anatomical threaded cages inserted on the left. Group 4 had anatomical threaded cages inserted on the left and fixed by right transpedicular screws. Group 5 had left inserted anatomical threaded cages and was fixed by left transpedicular screws. Group 6 had anatomical threaded cages inserted on the left side and was fixed by bilateral transpedicular screws. Nondestructive tests were performed in pure compression, flexion, extension, and lateral bending. Results: Unilateral discectomy and facetectomy had lower stiffness than normal FSU by 69% and 44% in pure compression, flexion, extension, and lateral bending. Single anatomical posterolateral cage group had higher stiffness than discectomy and facetectomy group, up by 55% and 28%. However, its stiffness was lower than normal FSU by 41% and 23%. Single anatomical cage with unilateral transpedicular screw fixation (left or right) had higher stiffness than normal FSU by 15% 17% and 20% 50% respectively. Single anatomical cage with transpedicular screw fixation was much stiffer than normal FSU by 18% and 65%. Conclusion: Adequate postoperative stability can be achieved by posterior lumbar interbody fusion with insertion of a single anatomical cage combined with a transpedicular screw.

BACKGROUND: The biomechanical studies about calcium sulfate cement vertebroplasty are only limited to the single fracture vertebra, not performed in spinal compression fracture unit with posterior transpedicular screw fixation. Furthermore, performing experimental study in the whole function spine unit (FSU) conforms to actual clinical situation. OBJECTIVE: To assess the biomechanical properties of calcium sulfate vertebroplasty combined with posterior transpedicular screw fixation in treatment of thoracolumbar compression fractures. DESIGN, TIME AND SETTING: A controlled experiment was performed at the Biomechanical Laboratory of Shanghai University in March 2009. MATERIALS: Fifteen fresh thoracolumbar spines were harvested from male calves and made into T_(11)-L_1 FSU, then divided into 3 groups randomly: normal control group, posterior transpedicular screw fixation group and transpedicular screw fixation plus vertebroplasty group. METHODS: T_(12) flexion-compression fracture models were made in all specimens of posterior transpedicular screw fixation group and transpedicular screw fixation plus vertebroplasty group, undergoing reduction and posterior transpedicular screw fixation, and calcium sulfate vertebroplasty combined with posterior transpedicular screw fixation respectively. MAIN OUTCOME MEASURES: All specimens were placed on the WE-10A universal testing machine for mechanical test. Load-straining, load-displacing, rigidity, strength and torsion of the FSU were performed in axial compression, flexion, extension and lateral bending states. The experimental outcomes were collected and compared by statistic analysis. RESULTS: The load-strain and loed-displacement showed a linear relationship. Straining values in vertebral body and intervertebral disc of calcium sulfate vertebroplasty plus posterior transpedicular screw fixation group were 14% and 12% less than that of posterior transpedicular screw fixation group, 21% and 13% less than that of normal control group. The thoracolumbar displacement in calcium sulfate vertebroplasty Plus posterior transpedicular screw fixation group decreased 25% and 37% as compared with other 2 groups respectively. Compared with normal control and posterior transpedicular screw fixation group, the thoracolumbar stiffness in calcium sulfate vertebroplasty plus posterior transpedicular screw fixation group increased 53% and 44% respectively. The strength in vertebral body and intervertebral disc of calcium sulfate vertebroplasty plus posterior transpedicular screw fixation group were 14% and 24% higher than that of posterior transpedicular screw fixation group, 13% and 20% higher than that of normal control group. The maximal twisting strength of FSU in calcium sulfate vertebroplasty plus posterior transpedicular screw fixation group were 18% and 30% higher than that of other 2 groups, the twisting stiffness were 30% and 40% higher than that of other 2 groups. The data above were significant differences statistically (P < 0.05). CONCLUSION: Posterior transpedicular screw fixation combined with calcium sulfate vertebroplasty show superior biomechanical properties for treatment of thoracolumbar compression fractures, which exhibits not only strong strength and stiffness, but also stable FSU, thus could decrease the stress loading of the internal fixation, the incidences of screw breakage and avoid the altitude loss of vertebral body.

Objective To quantify the expressions of tumor necrosis factor-α (TNF-α),caspase-8 and caspase-3 in lichen planus (LP) lesions,and to investigate their significance.Methods Skin samples were collected from the lesions of 20 patients with LP and normal skin of 20 healthy human controls.Immunohistochemistry was used to determine the expressions of TNF-αt,caspase-8 and caspase-3,and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) technique to evaluate the apoptosis in keratinocytes,in these samples.Results The expression levels (expressed in integrated optical density,IOD)of TNF-α,caspase-8 and caspase-3 were (12.58 ± 2.33) × 103,(11.69 ± 3.52) × 103 and (11.45 ± 2.82) × 103 respectively in LP lesions,significantly higher than those in the normal skin ((5.12 ± 1.78) × 103,(3.87 ± 3.36)× 103,(4.76 ± 1.93) × 103,t =11.38,7.19,8.76,respectively,all P ＜ 0.01).Elevated apoptosis index was noted in keratinocytes from LP lesions compared with those from normal skin (71.35 ± 7.93 vs.33.62 ± 8.75,t =14.29,P ＜ 0.01).In LP lesions,the expressions of both TNF-α and caspase-8 were positively correlated with the apoptosis index of keratinocytes (r =0.72,0.75,respectively,both P ＜ 0.01) and the expression of caspase-3 (r =0.68,0.73,respectively,both P ＜ 0.01).Conclusion The up-regulated expressions of TNF-α,caspase-8 and caspase-3 may participate in the apoptosis in keratinocytes in LP.

Objective To improve understanding of the clinical manifestations, diagnosis and treatment of childhood Kasabach-Merritt phenomenon (KMP). Methods The clinical data of 13 patients admitted for KMP to XXX from January 2010 to January 2016 was retrospectively analyzed, with a review of relevant literature. Results The patients were 10 males and 3 females. The age of presentation varied from newborn to 5 months. 12 patients had cutaneous manifestations, like petechiae, ecchymosis, jaundice, skin masses, etc, 1 patient had pleural effusion. The location of lesions varied. The laboratory hallmark consists of profound thrombocytopenia and hypofibrinogenemia with elevated D-dimers. The median time from initial presentation to diagnosis was 60 days. After approaches like surgery, corticosteroids, propranolol, interferon, sirolimus, etc, 10 patients got remission while 3 patients died. 6 patients treated with sirolimushad complete response. Conclusions KMP is characterized with vascular tumor, severe thrombocytopenia and consumptive coagulopathy. Clinically, KMP often presents with early-onset and delay in diagnosis. Surgery is an effective approach for KMP. Sirolimus appears to be a promising treatment for KMP.

Objective To explore the curative effect and adverse reactions through Cynergy dual wavelength laser to cure skin vascular pathological changes in children.Methods Cynergy dual wavelength (595 nm and 1064 nm) laser were used to treat the skin vascular pathological changes in children (650 cases) including strawberry-shaped hemangioma (398 cases) and port wine stain (252 cases).Anergy density was 5-15 J/cm2 and 30-80 J/cm2.The curative effect and adverse reaction and also the relationship between the port wine stain curative effect and the age of patient,location,and colour of skin lesions were analyzed.Results In total 650 cases after 3-7 times treatments under suitable pulse width and energy density,the curative effect for strawberry-shaped hemangioma was 92.2 ％,that for pink type port wine stain was 77.9 ％,that for purple type port wine stain was 38.9 ％,and that for thickening type port wine stain was 14.3 ％ ; the overall adverse reaction rate was 2.3 ％.After test with x2 analysis,the curative effect of port wine stain also varied depending on the age of patient,location,and colour of skin lesions.The younger the age of patient and shallower of colour of skin lesions,and the better the curative effect.The curative effect for location around the eyes was better than frontal face and limbs.Conclusions Application of Cynergy dual wavelength laser in treatment of the skin vascular pathological changes in children has notable curative effect and low adverse reaction.It is a new curative technology and also safe and reliable.It is worthy of popularization and application.

OBJECTIVETo investigate STK11 gene mutation in a pedigree with Peutz-Jeghers syndrome (PJS).

METHODSA pedigree of PJS was investigated. DNA was extracted from peripheral blood samples from affected and unaffected members of the pedigree and 100 unrelated healthy controls. PCR was performed to amplify all of the 9 coding exons of STK11 gene. PCR products were directly sequenced to detect mutation.

RESULTSA missense mutation p.F354L (c.1062C>G) in exon 8 of the STK11 gene has been identified in all patients with PJS, but was not found in normal individuals from the pedigree and 100 unrelated controls.

CONCLUSIONA missense mutation p.F354L of STK11 gene probably underlies the disease in this pedigree.

Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; DNA Mutational Analysis ; Exons ; Female ; Humans ; Male ; Molecular Sequence Data ; Pedigree ; Peutz-Jeghers Syndrome ; diagnosis ; enzymology ; genetics ; Protein-Serine-Threonine Kinases ; genetics

Objective: To assess the clinical features and long-term outcomes of neuroblastoma (NB) in children less than 18 months of age, so as to provide evidence for further improvement of treatment. Method: Clinical data(sex, age, stage, risk group, treatment response, follow-up, etc.) of 155 NB patients under age of 18 months from June 2000 to December 2015 in Shanghai Children′s Medical Center were analyzed retrospectively. The clinical features were summarized and the long-term follow-up results were evaluated. The overall survival (OS) and event-free survival (EFS) were analyzed by using Kaplan-Meier method. Factors including age, stage, risk group, bone marrow and bone metastasis, N-MYC status and dehydrogenase(LDH) level were analyzed by Log-Rank test. Result: Totally 155 eligible patients (96 males, 59 females) were included. The median age of disease onset was 7 months (11 days to 18 months). There were 31 cases of stage 1, 19 cases of stage 2, 45 cases of stage 3, 38 cases of stage 4 and 21 cases of stage 4S. The median follow-up time was 36 months (range 4 to 189 months), the 3-year and 5-year EFS rate were 89.6% and 85.2% respectively and the 3-year and 5-year OS rate were 96.2% and 94.1%, respectively. A total of 15 recurrent or progressed cases were observed. The median time to first recurrence was 11 months (range 3 to 39 months), 6 cases eventually died. Second malignancy occurred in one patient. The patients who had relapsed disease within 12 months from initial diagnosis have much lower 3-year OS rate than those in whom the disease recurred 12 months later (25.7% vs. 83.3%, P=0.020). Although the number of chemotherapy courses in median-high risk group reduced from 8.6 courses to 7.5 courses after the revision in 2008, the survival rate showed no significant difference between before and after (5-year EFS 74.4% vs. 84.3%, 5-year OS 89.0% vs. 92.9%, both P>0.05). In patients with stage 1 and stage 2, the 3-year EFS of 34 cases with surgery alone and 16 cases accepted chemotherapy were both 100%. Age at diagnosis, stage, risk group, MYCN status, LDH level, bone marrow involvement and bone infiltration had significant impacts on prognosis(all P<0.05). Conclusion Satisfactory outcomes could be achieved in neuroblastoma in children aged within 18 months; the prognosis was better in children at age less than 12 months compared with 12-18 months. MYCN amplification, LDH more than 5 times upper limit of normal range, bone marrow and bone infiltration were associated with worse prognosis.Excellent survival rates could be achieved in children with stage 1 and 2 disease within 18 month′s old accepted surgery alone, chemotherapy or radiotherapy could be avoided in these patients so as to reduce long-term adverse reactions.

Objective:To explore the value of diffusion tensor imaging (DTI) in evaluating the effects of hyperbaric oxygen therapy (HOT) in treating spinal cord injury.Methods:The modified Allen′s method was used to induce a traumatic spinal cord injury in 30 rats who were then divided randomly into an injured group and a treatment group, each of 15. The treatment group was given HOT twice a day for 3 days, then once a day for a total of 4 weeks. The injured group did not receive HOT. DTI was performed (along with Basso-Beattie-Bresnahan (BBB) evaluation) at 0h, 6h, 24h, as well as 3, 7, 14, 21 and 28 days after the operation. Two-factor repeated measures ANOVA was conducted to analyze any differences in the DTI results: the fractional anisotropy, mean apparent diffusivity, radial diffusivity and axial diffusivity, as well as the BBB scores. LSD t-tests were performed to analyze the significance of the differences at different time points.Results:At each time point after 24h the average FA value of the treatment group was significantly higher than the injured group′s average, while its average MD and RD values were significantly lower. Beyond 14 days the average AD value of the treatment group was significantly higher than that of the injured group. The treatment group′s average BBB score was also significantly higher at all the time points beyond 3 days.Conclusions:DTI results can evaluate spinal cord function and provide valuable information for the dynamic assessment of hyperbaric oxygen therapy after a traumatic spinal cord injury, and the therapy promotes the recovery of motor function, at least in rats.

Epidemiologic, clinical and imaging data were collected from 14 children with confirmed coronavirus disease 2019 (COVID-19) admitted in Beijing Ditan Hospital from January 27, 2020 to February 12, 2020. There were 6 boys and 8 girls with a median age of 3.5 years (6 months-9.4 years). Four patients had a history of travel to Wuhan City or Hubei Province and 2 patients had contacted with people from Wuhan; 13 patients were familial cluster of infection. The incubation period was 4 to 16 days. The clinical manifestations were fever in 8 cases, cough in 5 cases, diarrhea in 1 case; and 2 cases were asymptomatic. Four patients had abnormal peripheral blood routine, including 1 had lymphocytosis, 3 had lymphocytopenia; 3 patients had a slightly elevated CRP, and 3 patients had hepatic dysfunction. Thirteen patients underwent chest CT; and 1 case showed bilateral lung glass exudation, 1 case showed multiple patchy high density shadows of bilateral lung. One patient underwent chest X-ray examination, which was showed no abnormal findings. The pediatric patients with COVID-19 in this series generally have a traceable epidemiological history. The clinical manifestations are fever, cough and diarrhea. Peripheral white blood cell counts were most normal. Chest CT reveals less severe changes than those in adults, most child patients show no manifestation of pneumonia.