BACKGROUND:Atlantoaxial anatomical structures were special. Compared with thoracolumbar vertebrae, there is no fixed anatomical marker for screw implantation. Moreover, pedicle structural variation is great. The current consensus view is to suggest an individualized program of pedicle screws. The development of orthopedic digital software technology provides a novel manner for preoperative design.
OBJECTIVE:To original y design 3D matrix model, to observe atlas pedicle channel, pedicle screw safety zone, to measure optimal program for screw fixation, and to simplify preoperative design of entering pedicle screw.
METHODS:Continuous atlas CT data of 12 healthy adults in picture archiving and communication system of People’s Hospital, Three Gorges University were imported into Mimics 10.01 software. There were seven males and five females, at the age of 30-65 years old, averagely 45 years. After three-dimensional reconstruction, the three-dimensional reconstruction models were imported into 3Dmax 2009 as .dwg format. The reference three-dimensional planes and the sites of nail insertion were determined by the atlas modeling. The modeling consisted of 17×17×2 elements and the transverse section angles ranged from 0° to 40° and the sagittal section angles ranged from 0° to 40° with a space of 2.5°. 578 elements were used to simulate pedicle screw array model. Perspective observation showed that the diameter was 3.5 mm, and length was 22 mm in pedicle channel. Thus, safety area, best screw channel and screw angle were analyzed.
RESULTS AND CONCLUSION:The total number of elements in the matrix study was 17×17×2×12 in 12 subjects. 175 screws in total of 6 936 units could safely meet the operative standard. No significant difference in the number of pedicle screw between left and right sides (P>0.05). Results indicated that the digital three-dimensional modeling technology is an effective, simple, accurate way in the preoperative design and measurement for atlas pedicle surgery.

Objective Moyamoya disease is a progressive cerebrovascular occlusive disease. The etiology of the disease is unknown. most think that Moyamoya usually presents with cerebral ischemia in children and intracranial hemorrhage in adults. But we have some adults present with cerebral ischemia .This article will help us know better about moyamoya disease in adults present with cerebral ischemia. And will let us know better about treatment and prognosis of this disease.Methods We reviewed our experience 88 adults angiographically diagnosed patients with moyamoya. There are 49 patients with moyamoya disease initially present with cerebral ischemia. We report their clinical presentation, radiological findings, management, and clinical outcomes. Results The incidence of moyamoya disease presents with cerebral ischemia is 55.7% in adults .The mean age of patients at symptom onset was 32 years (range, 18~64 years). Ischemic strokes or transient ischemic attacks were the predominant initial presentations.7 cases present intracranial haemorrhage in follow-up period. There was no difference in clinical representation, image and cerebral infarction in this 7 case.Conclusions Moyamoya usually presents with cerebral ischemia in adults higher than we think. diagnosis and treatment of moyamoya disease in adults is essential to minimize residual mental and physiologic deficits. If we find patients 30-40 years old ,with cerebral infarction that can’t explain in conventional mode, we should pursuit these patients, in order to exclude Moyamoya disease .Structured multicenter randomized clinical trials are needed to further assess the best treatment modalities for patients with moyamoya.

ObjectiveTo investigate the relationship between intervertebral disc pressure and clinical efficacy after the minimally invasive treatment of cervical disc herniation. MethodsForty-seven patients with cervical disc herniation treated by disc radiofrequency ablation, and monitored the intervertebral disc pressure after that. Moreover, the correlation between the pressure and the clinical efficacy was observed. ResultsAll cases were successfully completed under pressure monitoring. Forty-seven cases underwent a follow-up of 1-25 months,according to JOA score,using postoperative improvement rate (Hirabashi formula) to assess the clinical efficacy. High efficacy in 25 cases,fine efficacy in 19 cases,good efficacy in 3 cases,high and fine efficacy rate was 93.6％ (44/47). The postoperative intervertebral discpressure was significantly correlated with improvement rate after cervical minimally invasive surgery (P ＜0.05). ConclusionsRadiofrequency ablation treatment of cervical disc herniation is safe and effective minimally invasive technique. If the pressure in the postoperative intervertebral disc is 3 kPa,it will get better prognosis.

A novel unsaturated polyphosphoester (UPPE) was devised in our previous research, which is a kind of promising scaffold for improving bone regeneration. However, the polymerization process of UPPE scaffolds was unfavorable, which may adversely affect the bioactivity of osteoinductive molecules added if necessary, such as recombinant human bone morphogenetic protein-2 (rhBMP2). The purpose of this study was to build a kind of optimal scaffold named UPPE-PLGA-rhBMP2 (UPB) and to investigate the bioactivity of rhBMP2 in this scaffold. Furthermore, the cytotoxicity and biocompatibility of UPB scaffold was assessed in vitro. A W1/O/W2 method was used to fabricate PLGA-rhBMP2 microspheres, and then the microspheres were added to UPPE for synthesizing UPB scaffold. The morphological characters of PLGA-rhBMP2 microspheres and UPB scaffolds were observed under the scanning electron microscopy and laser scanning confocal microscopy. The cumulative release of UPB scaffolds was detected by using ELISA. The cytotoxicity and biocompatibility of UPB scaffolds were evaluated through examining the adsorption and apoptosis of bone marrow stromal cells (bMSCs) seeded on the surface of UPB scaffolds. The bioactivity of rhBMP2 in UPB scaffolds was assessed through measuring the alkaline phosphates (ALP) activity in bMSCs seeded. The results showed that UPB scaffolds sequentially exhibited burst and sustained release of rhBMP2. The cytotoxicity was greatly reduced when the scaffolds were immersed in buffer solution for 2 h. bMSCs attached and grew on the surface of soaked UPB scaffolds, exerting well biocompatibility. The ALP activity of bMSCs seeded was significantly enhanced, indicating that the bioactivity of rhBMP2 remained and still took effect after the unfavorable polymerization process of scaffolds. It was concluded that UPB scaffolds have low cytotoxicity, good biocompatibility and preserve bioactivity of rhBMP2. UPB scaffolds are promising in improving bone regeneration.

Objective To investigate the efficacy and safety of low-dose rituximab therapy and sequential maintenance for patients with refractory idiopathic thrombocytopenic purpura. Methods Thirty-three patients with refractory idiopathic thrombocytopenic purpura received intravenous rituximab at the dose of 100 mg once a week for 4 consecutive weeks. Complete blood cell count and serum concentrations of immunoglobulin (IgG,IgM and IgA) were monitored regularly. The numbers of CD3+ and CD19+ CD20+ lymphocyte cells were assayed by flow cytometry before and after therapy. Twenty-five patients with responses(complete response and response) were divided into maintained group (12 patients) and control group (13 patients) by random digits table method. The patients in maintained group were treated with rituximab 100 mg every 6 months. The efficacy of maintenance therapy was evaluated through long-term follow-up. Results The complete response(CR) rate, response (R) rate and no response(NR) rate were 48.48%(16/33), 27.27%(9/33) and 24.24% (8/33), respectively. As a result, total effective rate was 75.76% (25/33). There were no significant changes of peripheral blood white blood cell count,hemoglobin,serum immunoglobulin and CD3+lymphocyte counts before and after treatment (P>0.05). However, CD19+ CD20+ cells were almost depleted in patients treated with rituximab: (3.71±2.64)×106/L vs. (279.33±92.78)×106/L, P<0.01. Five patients suffered from allergic response, and 1 patient developed pneumonia and respiratory failure. The relapse rates of maintained group and control group were 1/12 and 4/13, respectively. Conclusions Treatment with low-dose rituximab may be an effective and safe approach in patients with idiopathic thrombocytopenic purpura. Relapse rates can be decreased through maintenance therapy with refractory low-dose rituximab. However, the optimal therapeutic schedule need further investigation.

BACKGROUNDHypocretin (HCRT) signaling plays an important role in the pathogenesis of narcolepsy and can be significantly influenced by Chinese herbal therapy. Our previous study showed that xingshentongqiao decoction (XSTQ) is clinically effective for the treatment of narcolepsy. To determine whether XSTQ improves narcolepsy by modulating HCRT signaling, we investigated its effects on SH-SY5Y cell proliferation, apoptosis, and HCRT receptor 1/2 (orexin receptor 1 [OX1R] and orexin receptor 2 [OX2R]) expression. The signaling pathways involved in these processes were also assessed.

METHODSThe effects of XSTQ on proliferation and apoptosis in SH-SY5Y cells were assessed using cell counting kit-8 and annexin V-fluorescein isothiocyanate assays. OX1R and OX2R expression was assessed by quantitative real-time polymerase chain reaction analysis. Western blotting for mitogen-activated protein kinase (MAPK) pathway activation was performed to further assess the signaling mechanism of XSTQ.

RESULTSXSTQ reduced the proliferation and induced apoptosis of SH-SY5Y cells. This effect was accompanied by the upregulation of OX1R and OX2R expression and the reduced phosphorylation of extracellular signal-regulated kinase (Erk) 1/2, p38 MAPK and c-Jun N-terminal kinase (JNK).

CONCLUSIONSXSTQ inhibits proliferation and induces apoptosis in SH-SY5Y cells. XSTQ also promotes OX1R and OX2R expression. These effects are associated with the repression of the Erk1/2, p38 MAPK, and JNK signaling pathways. These results define a molecular mechanism for XSTQ in regulating HCRT and MAPK activation, which may explain its ability to treat narcolepsy.

Apoptosis ; drug effects ; Blotting, Western ; Cell Proliferation ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Mitogen-Activated Protein Kinases ; metabolism ; Orexin Receptors ; metabolism ; Real-Time Polymerase Chain Reaction

A novel unsaturated polyphosphoester (UPPE) was devised in our previous research, which is a kind of promising scaffold for improving bone regeneration. However, the polymerization process of UPPE scaffolds was unfavorable, which may adversely affect the bioactivity of osteoinductive molecules added if necessary, such as recombinant human bone morphogenetic protein-2 (rhBMP2). The purpose of this study was to build a kind of optimal scaffold named UPPE-PLGA-rhBMP2 (UPB) and to investigate the bioactivity of rhBMP2 in this scaffold. Furthermore, the cytotoxicity and biocompatibility of UPB scaffold was assessed in vitro. A W1/O/W2 method was used to fabricate PLGA-rhBMP2 microspheres, and then the microspheres were added to UPPE for synthesizing UPB scaffold. The morphological characters of PLGA-rhBMP2 microspheres and UPB scaffolds were observed under the scanning electron microscopy and laser scanning confocal microscopy. The cumulative release of UPB scaffolds was detected by using ELISA. The cytotoxicity and biocompatibility of UPB scaffolds were evaluated through examining the adsorption and apoptosis of bone marrow stromal cells (bMSCs) seeded on the surface of UPB scaffolds. The bioactivity of rhBMP2 in UPB scaffolds was assessed through measuring the alkaline phosphates (ALP) activity in bMSCs seeded. The results showed that UPB scaffolds sequentially exhibited burst and sustained release of rhBMP2. The cytotoxicity was greatly reduced when the scaffolds were immersed in buffer solution for 2 h. bMSCs attached and grew on the surface of soaked UPB scaffolds, exerting well biocompatibility. The ALP activity of bMSCs seeded was significantly enhanced, indicating that the bioactivity of rhBMP2 remained and still took effect after the unfavorable polymerization process of scaffolds. It was concluded that UPB scaffolds have low cytotoxicity, good biocompatibility and preserve bioactivity of rhBMP2. UPB scaffolds are promising in improving bone regeneration.
Bone Morphogenetic Protein 2 ; chemistry ; pharmacology ; Bone Regeneration ; drug effects ; Humans ; Lactic Acid ; chemistry ; pharmacology ; Phosphatidylinositol Phosphates ; chemistry ; pharmacology ; Polyglycolic Acid ; chemistry ; pharmacology ; Tissue Scaffolds

Objective To explore the effect of intermittence oro-esophageal tube feeding on the comfort and swallowing function of paralytic patients with swallowing disorder.Methods A total of 80 paralytic patients with dysphagia who were hospitalized in Neurology Department of the First Affiliated Hospital of Zhengzhou University from January to December 2016 and met the inclusion criteria were selected by convenience sampling method and divided into observation group and control group according to random number table, with 40 cases in each group. Intermittence oro-esophageal tube feeding was used in observation group, and nasogastric feeding was used in control group. The nasopharyngeal comfort of both groups on the third and tenth day of intervention and patients' swallowing function before feeding and on the tenth day of intervention were compared respectively.Results On the third and tenth day of intervention, the differences between the two groups on the symptoms of nasal discomfort, throat pain, oropharyngeal dryness and swallowing discomfort were statistically significant (P<0.01). There was no statistical difference in the extent of swallowing disorder between the two groups before intervention (P>0.05). Comparing the two groups on the tenth day of intervention, the difference of patients' swallowing function was statistically significant (P<0.01). Patients' swallowing function recovery on the tenth day of intervention was statistically different between the two groups (P<0.01). Conclusions Intermittence oro-esophageal tube feeding can significantly improve the comfort and the swallowing function in stroke patients. Thus, intermittence oro-esophageal tube feeding is a worthy method to expand in clinical practice.

Objective?To analyze the mediating effects of the sense of coherence between mental stress and depression in stroke patients, and to offer guidance and assistance to reducing mental stress and depression and improving mental health in stroke patients. Methods?Totally 468 stroke patients were selected from the Department of Neurology of a ClassⅢ Grade A hospital in Zhengzhou by convenient sampling between July 2016 and July 2017 and investigated with Sense of Coherence Scale (SOC-13), Chinese Perceived Stress Scale (CPSS) and Center for Epidemiologic Studies Depression Scale (CES-D). The data were statistically analyzed with SPSS 21.0 and AMOS 22.0. Results?The total average scores for SOC-13, CPSS and CES-D in these stroke patients were (63.39±9.92), (41.65±7.29) and (23.80±4.20), respectively. The sense of coherence was negatively correlated with mental stress and depression (r=-0.47,-0.51;P＜0.01), and mental stress was positively correlated with depression (r=0.52,P＜0.01). As a meditating variable, the sense of coherence reduced the adverse prediction effects of mental stress on depression from 0.632 to 0.283. According to the re-analysis of the structural equation model, the sense of coherence was the mediating variable between mental stress and depression. The fit indexes were good (χ2/df=2.450, GFI=0.942,AGFI=0.941, CFI=0.940, TLI=0.922, RMSEA=0.052, RMR=0.036). Conclusions?As the mediating effect between mental stress and depression, the sense of coherence reduces the adverse prediction effects of mental stress on depression to some extent. Therefore, the sense of coherence in stroke patients shall be enhanced to improve their mental health and reduce the incidence of depression.

Objective:To investigate the effects of Shenghui Yizhi Decoction on learning and memory ability of SAMP8 mice; To explore its mechanism.Methods:Totally 24 male SAMP8 mice were randomly divided into model group, donepezil hydrochloride group (1 mg/kg) and Shenghui Yizhi Decoction group (15.6 g/kg), with 8 mice in each group, and eight anti rapid aging mice (SAMR1) of the same age and strain were set as the control group. The mice in each group were given corresponding medication or the same volume of distilled water for 90 days. After administration, Morris water maze was used to detect the learning and memory ability and space exploration ability of mice. Immunohistochemistry was used to detect expression of β Amyloid protein 1-42 (Aβ 1-42) in hippocampal. ELISA was used to detect the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Real time PCR was used to detect expressions of NOD-like receptor thermal protein domain associated protein 3 (NLRP3), cysteine protease-1 (Caspase-1), and IL-1β mRNA. Western Blot was used to detect expression of NLRP3, Caspase-1and IL-1β protein. Results:Compared with model group, the spatial exploration ability and memory ability of mice in Shenghui Yizhi Decoction group and donepezil hydrochloride group were improved ( P<0.05, P<0.01), the expression of Aβ 1-42 in hippocampus decreased ( P<0.05, P<0.01), the contents of IL-1β, IL-6 and TNF-α decreased ( P<0.05, P<0.01), and the mRNA and protein expressions of NLRP3, Caspase-1 and IL-1β decreased ( P<0.05, P<0.01). Conclusion:Shenghui Yizhi Decoction can effectively improve the learning and memory ability of SAMP8 mice, and its mechanism may be related to inhibiting the activation of inflammasome and neuroinflammatory response by regulating the NLRP3/ Caspase-1/ IL-1β signaling pathway.