Objective To discuss the short-term clinical effect of K-Rod pedicle dynamic fixation system for multiple segmental lumbar degeneration. Methods From January 2010 to October 2012,28 patients with multiple segmental lumbar degeneration who were accepted K-Rod pedicle dynamic fixation system were retrospectively reviewed. The short-term clinical effect were based on Oswestry disability index score,visual analogous scale ( VAS) ,improvement rate of low back pain,postoperative lumbar hyperextension, hyperbend X-ray film lumbar ROM value ( lumbar flexion mobility) ,average operation time, intraoperative blood loss. Results All of 28 cases were achieved 12 ~24 months follow-up,the difference of Oswestry disability index score and visual analogous scale ( VAS) between 12 months postoperatively and preoperatively were statistically significant,the improvement rate of low back pain was (87. 0 ± 2. 0)%,the average operation time was (99. 6 ± 16. 2) minutes,the average blood loss was (70. 5 ± 31. 5)mL,the average length of stay(ALOS) was (11. 2 ± 2. 6) days after sur-gery. Conclusion K-Rod pedicle dynamic fixation system in the treatment of multiple segmental lumbar degeneration can obtain satisfactory short-term clinical effect.

Objective To discuss the clinical effect and the notes of atlas lateral mass screws combined with posterior epistropheus ped-icle screws for the treatment of atlantoaxial joint instability. Methods In our hospital from January 2006 to January 2011,48 cases of atlan-toaxial joint instability accepted operation of the atlas lateral mass screws combined with epistropheus pedicle screws were analyzed. Results All patients with follow-up time 12~24 months,an average of 17 months,were achieved primary healing and atlanto-axial intervertebral osse-ous healing. Besides postoperative neck pillow area pain improved and nerve function get a degree of recovery,there was no inner fixed damage cases. Complications of operation include venous plexus hemorrhage was in 2 cases,cervical occipital pain and numbness increase in 3 cases,cere-brospinal fluid leak in 2 cases,vertebral artery extrusion occlusion after cerebral ischemic symptoms in 1 case. Conclusion Combination of atlas lateral mass screws and posterior epistropheus pedicle screws technique is one of the effective means of treatment of atlantoaxial joint instabili-ty and can obtain satisfactory clinical effect. Standard operation performance is the key to reduce or even eliminate surgical complications.

Objective Currently there is little study on the K-Rod pedicle fixation system in the treatment of far lateral lum-ber disc hernaition with multiple segment degeneration.The study was to compare the short-term efficay of K-Rod pedicle dynamic fixa-tion system and lumbar fusion for far lateral lumber disc herniation with multiple segment degeneration. Methods Retrospective a-nalysis were made on 56 patients with lumbar intervertebral disc herniation with multiple segment degeneration who received operation in General Hospital of Shenyang Military Region from January 2010 to October 2012.They were divided into K-Rod group (combined treatment of lumbar fusion and adjacent degenerative segment unfusion) and traditional fusion group according to different treatments. 28 patients in K-Rod group were treated with K-Rod pedicle dynamic fixation system and 28 cases in traditional fusion group were trea-ted with traditional lumbar fusion and internal fixation.Comparative analysis were made on the indexes before and after operation be-tween two groups, including Oswestry disability index, visual analogous scale (VAS) ,improvement rate of low back pain, postopera-tive lumbar spine X-ray, operation time, intraoperative blood loss and postoperative average length of stay. Results 12 to 24 months follow-up were achieved on 56 cases.The Oswestry function score and visual analog scale for both groups were improved significantly at 12 months after operation, and the difference was of statistical significance (P<0.05).Oswestry function scores and vis-ual analog scales between two groups were of no significant difference either before operation or after operation (P>0.05), while the average operation time ([119.6 ±14.2] min vs [155.5 ±17.5]min), the average blood loss ([235.5 ±32.5] mL vs [367.5 ±29. 5] mL), the average length of stay (ALOS) ([10.5 ±2.2] vs [14.2 ±2.6]d) between K-Rod group and traditional fusion group were of significant difference(P<0.05). Conclusion In the treatment of far lateral lumber disc hernaition with multiple segment degeneration, the K-Rod pedicle dynamic fixation system atrributes to less intraoperative blood loss, shorter operation time and little postoperative effect on lumbar spine mobility.

Objective The purpose was to compare the biomechanical characteristics of new percutaneous guide wire and conventional wire in cadaveric spines,and to evaluate the new percutaneous guide wire's efficacy and safety in a clinical trial.Methods Compared the push-out and penetration forces of the new percutaneous guide wire and conventional wire in fresh cadaveric lumbar spines from L1 to L5.And analyzed the related complications of new percutaneous guide wire by clinical experiment.Results Push-out forces caused the spiral part of the new percutaneous guide wire to bend or spread,so as to resist the anterior migration of the guide wire.The mean push-out forces of the new percutaneous guide wire and conventional wire were (15.5-+ 1.9) N and (5.7 ± 0.8) N respectively (P ＜ 0.01),and the mean penetration forces were (69.1 ±4.2) N and (37.1 ±4.8) N respectively (P ＜0.01).There was no wire breakage or anterior-wall penetration in the clinical trial of 222 new percutaneous guide wire.Conclusion The mean push-out and penetration forces of the new percutaneous guide wire were approximately 2 to 3 times greater than those of conventional wire.The new percutaneous guide wire effectively prevented guide-wire anterior migration and penetration of the anterior vertebral-body wall.The new percutaneous guide wire device could effectively improve the safety of percutaneous pedicle screw insertion procedures for patient with osteoporosis.

Objective To identify shortcomings in the current evaluation index system of medical quality. Methods The documentary analysis focused on the existing index system comprises the Hospital Management and Quality Evaluation Standards (2007) by China Hospital Association, Hospital Management Evaluation Guidelines (2005) by the Ministry of Health, and Implementation Rules of Hospital Management Evaluation Standards for Beijing (2007). JCI Accreditation Standards for Hospitals (edition 2) (2003), and New Hospital Accreditation Standards for Taiwan (2005, 2006) were referred to in the study. Results The shortcomings found include the weak operability of indexes, and the deficiency of evaluation indexes from the point of hospital visiting process by patients. Conclusion In view of the hospital visiting process of patients, add more indexes for patients' hospital visiting process,and quantize and highlight the operability of indexes, with summary and optimization of experiences in time by steps.

OBJECTIVETo observe the effects of electroacupuncture (EA) at "Dazhui" (GV 14) on Wnt-β-catenin signal pathway in annulus fibrosus cells in intervertebral disc in rats with cervical spondylosis.

METHODSForty SD rats were randomized into a control group, a model group, an EA group and a medication group, 10 rats in each one. Rats in the control group were treated with sham operation, only incision on local skin; rats in the remaining groups were made into cervical spondylosis models. After model establishment, rats in the control group and model group received fixed treatment under identical condition; rats in the EA group were treated with EA at "Dazhui" (GV 14), 30 min per treatment; rats in the medication group were treated with intragastric administration of meloxicam tablets. Treatments were both given once a day, and 14 days were taken as one session; there was an interval of 2 days between two sessions, and totally two sessions were given. After the treatments, immunohistochemistry was applied to measure the expression of Wnt, glycogen synthase kinase-3β (GSK-3β) and Axin in annulus fibrosus cells; western blot was used to test the expression of P-β-catenin.

RESULTSIn the control group, there were more positive cells of Wnt, GSK-3β and Axin, which were intensively distributed, deeply colored, and strongly positive; In the model group, there were less positive cells of Wnt, GSK-3β and Axin, which were sparsely distributed and weakly positive. The expression of Wnt, GSK-3β, Axin and P-β-catenin in the model group was less than that in the control group (all P < 0.05); expression of Wnt, GSK-3β, Axin and P-β-catenin in the EA group and medication group was higher than that in the model group (all P < 0.05); expression of Wnt, GSK-3β, Axin and P-β-catenin was not significantly different between EA group and medication group (all P > 0.05).

CONCLUSIONEA could delay the degeneration of intervertebral disc, which may be related to EA inhibiting signal pathway of Wnt-β-catenin.

Acupuncture Points ; Animals ; Electroacupuncture ; Female ; Fibrosis ; Glycogen Synthase Kinase 3 ; genetics ; metabolism ; Humans ; Intervertebral Disc ; metabolism ; pathology ; Male ; Rats ; Spondylosis ; genetics ; metabolism ; pathology ; therapy ; Wnt Signaling Pathway ; beta Catenin ; genetics ; metabolism

Objective The aim of this study was to provide methods for predicting ideal trajectory and position of C1 lateral mass screw (C1 LMS)from plain radiographs.Methods A total of 40 consecutive subjects (with 79 screws)who had undergone C1 LMS placement were enrolled.To evaluate the C1 LMS position,the positions of screw head and tips on anteroposterior radiographs,screw length,and height on lateral radiograph were graded as 0°,Ⅰ°,and Ⅱ°,respectively.On the postoperative computed tomography images,the lateral mass (LM) perforation,screw-thread engagement percent(%),bicortical fixation,extruded screw length,and violation of adjacent joints were analyzed. Results Screws with tip located medial to LM(tip 0)showed LMperforation in all cases.Polyaxial head located within the LM(head 0)or crossing the lateral margin of the LM(head Ⅰ)showed no LMperforation.Screw-thread engagement percent was the highest with head Ⅰ-tip Ⅰ (medial half of LM)position (97.6%),followed by head 0-tip Ⅰ (90.5%)and head Ⅰ-tip Ⅱ (lateral half of LM)(86.4%). Screws longer than the posterior half of C1 anterior arch (AA)showed bicortical fixation in all cases with mean extruded screw length of 1.9 mm.Adjacent joint was not violated in 98%,with the screw height below half of C1 AA.Conclusion On an anteroposterior radiograph, a C1 LMS with the screw head located on the lateral margin of the LMand with the screw tip in the medial half of the LMresulted in the safest and longest trajectory.On lateral radiograph,a screw tip that is placed within the anterior-inferior quadrant of the C1 AA results in safe bicorti-cal fixation without injury to the adjacent structures.These plain radiographic findings may be helpful bothpostoperatively and intraoperatively for assessing the trajectory and length of the screw.

Objective To investigate the epidemiological characters of human metapneumovirus (hMPV) infection in children with influenza-like illness (ILI).Methods A total of 1 164 throat swabs were collected from children with ILI symptoms in Children's Hospital,Zhejiang University School of Medicine from January 2011 to December 2012.hMPV was detected by using nucleic acid assay,the fusion (F) protein gene of hMPV was amplified by RT-PCR,gene sequencing was performed and the sequences were compared with those in GenBank.Positive rates of hMPV in different age groups were compared with Chi-square test.Results Among 1 164 samples,hMPV was positive in 73 (6.27％) samples.hMPV infection was the most popular in ＞2-4 y age group (33/220,15.0％),and the positive rates of hMPV in different age groups were of statistical significance (x2 =40.69,P ＜ 0.05).hMPV infection occurred throughout the year,but it was most common in winter and spring.The highest incidence of hMPV infection was observed in December 2012 (12/51,25.53％).Among 24 samples of hMPV,14 were with genotype B1,2 were with genotype B2,and 8 were with genotype A2.The most common genotype was B1 in 2011 (10/12),and A2 in 2012 (8/12).Homology between nucleotide sequences of the 24 samples of hMPV were 81.6％ to 100.0％.Conclusions hMPV infection exists in children with ILI in Hangzhou,and the epidemic seasons are winter and spring.hMPV infection is more likely to be found in children aged 2 to 4 years old,and different genotypes may predominated alternately.

One hundred and fifty two actinomycetes were isolated from forty two radiation-polluted soil samples,using six different isolation media. Sixty cultures were chosen for 16S rRNA gene sequence and systematic analysis,which based on their morphology and ARDRA. Results of 16S rRNA gene sequences blasting showed that the strains were assigned to 12 recognized genera of actinomycetes,most of them fall within Streptomyces genus and a great deal of strains belonged to rare actinomycetes,which indicated a rich diversity of actinomycetes in the radiation-polluted soil.

Objective To detect the global level of histone 4 lysine 20 (H4K20) methylation and its relation with DNA damage-repair in peripheral blood cell of arsenic-exposed residents in the coal-contaminated arsenism areas in Guizhou,in order to provide a basis to deepen the interpretation of the role of arsenic in inhibiting DNA damage-repair.Methods Jiaole village in coal-burning-borne arsenism areas in Xingren County of Guizhou was selected as the survey point,and 115 cases of arsenic-exposed residents were selected as the arsenic exposed group on the basis of physical examination.Moreover,53 residents from one village of non-epidemic area neighboring the diseased area were selected as controls.Hair and peripheral blood samples of these subjects were collected,and the histone protein was extracted from the lymphocytes separated from blood samples.The hair samples were digested with microwave digestion instrument,and the hair arsenic content was tested via the inductively coupled plasma-mass spectrometry (ICP-MS) method;the level of H4K20 1,2,3 methylation (H4K20me2,me2,me3) in peripheral blood cell was tested by enzyme-linked immunosorbent assay (ELISA);DNA damage of peripheral blood cell was measured by single cell gel electrophoresis (SCGE).Results The testing results of hair arsenic contents showed that the arsenic levels of hair in arsenic exposed group [0.30 (0.19-0.46)μg/g] were significantly higher than those of control group [0.12 (0.08-0.18) μg/g,F=11.968,P ＜ 0.05].Compared with the control (0.44 ± 0.14,0.99 ± 0.41,1.06 ± 0.33),the level of H4K20me1 (0.60 ± 0.29) in arsenic exposed group was higher (F =2.513,P ＜ 0.05),H4K20me2 (0.75 ± 0.26) was lower (F =4.707,P ＜ 0.05),and H4K20me3 (1.20 ± 0.62) was of no significant difference (F =0.582,P ＞ 0.05).The detecting results of DNA damage of the lymphocytes separated from peripheral blood showed a statistically significant increase (F =9.307,9.457,all P ＜ 0.05) in TailDNA％ and Olivetailmoment in arsenic exposed group [Median (M):10.75,11.69]compared with those of control group (M:2.12,1.16).The correlation analysis indicated that the arsenic levels of hair of subjects were positively correlated with H4K20me1 (r =0.214,P ＜ 0.05) and inversely with H4K20me2 (r =-0.224,P ＜ 0.05);H4K20me1 was positively associated with TailDNA％ (r =0.383,P ＜ 0.05) and Olivetailmoment (r =0.380,P ＜ 0.05);H4K20me2 was inversely associated with TailDNA％ (r =-0.290,P ＜ 0.05) and Olivetailmoment (r =-0.298,P ＜ 0.05).Conclusion H4K20 methylated modification makes a response to arsenic exposure of human body,the alteration of H4K20mel/me2 may participate in regulating DNA damage-repair induced by arsenic in vivo.