Objective To explore the expression and effect of interleukin(IL)-18 after hypoxic-ischemic brain damage(HIBD) in neonatal rats. Methods The HIBD model of seven-day-old Wistar rats was established. The mRNA and protein for IL-18 in cerebral cortex of control group, HIBD3 h, 8 h, 24 h, 3 d, 6 d and 14 d group were analyzed by RT-PCR and immunohistochemistry respectively, at the same time histological changes were observed. Results The expression of IL-18 mRNA and protein was low in control group[mRNA: 0.321 8?0.046 6; protein: (6.033? 1.019)cells/field]. After HIBD, the level of mRNA/protein for IL-18 in ischemic cortex increased progressively at 24 h to 6 d [mRNA: 24 h: 0.582 3?0.074 0, 3 d:0.697 6 ?0.107 3, 6 d: 0.911 0?0.064 7; protein: 24 h: (19.133?2.094)cells/field, 3 d: (28.900 ?1.589) cells/field, 6 d: (52.883?3.203)cells/field; P

Objective To explore the feasibility of the treatment of special types of lumbar disc herniation using microendoscopic discectomy system(MED-Ⅱ) Methods Posterior interlaminal approach microendoscopic discectomy using the MED-Ⅱ was employed in 53 cases of bi-interspace lumbar disc herniation,75 cases of central type lumbar disc herniation,and 9 cases of extraforaminal lumbar disc herniation.Results All the operations were successfully completed with an operation time of(60~110 min) (mean,70 min) and an intraoperative blood loss of 50~130 ml(mean,70 ml).The length of hospital stay was 5~19 days(mean,13 days).The stitches were taken out at 12 days after operation and the sutured wound healed by first intention in all the cases.Follow-up for 3~8 months(mean,5 months) showed no complications.According to the Nakai classification,there were 40 cases of excellent results,11 cases of good results,and 2 cases of fair in the 53 cases of bi-interspace lumbar disc herniation.Of the 75 cases of central lumbar disc herniation,53,17,and 4 cases were endowed excellent,good,and fair results,respectively,and 1 case got a poor result.Of the 9 cases of extraforaminal lumbar disc herniation,the numbers were 6,2,and 1,respectively.(Conclusions) Use of the MED-Ⅱ for the treatment of special types of lumbar intervertebral disc herniation is effective.

Objective To study the surgical techniques,indications and clinical effects of microendoscopic lumbar discectomy with the preservation of the ligamentum flavum.Methods A total of 65 patients with lumbar disc herniation were enclosed in the study.All the patients suffered from low back pain and radicular syndrome.The diagnosis was confirmed with CT scanning and/or MRI examination.The Microscope Endoscopic Tubular Retractor System(METRx) was used to access the interlaminar space.The superior,inferior and lateral edges of the ligamentum flavum were released using a micro-scalpel.The nerve root was retracted medially with a nerve root retractor to expose the herniated lumbar disc for performing the discectomy.The dissociative ligament was restored anatomically after disc removal and the decompression of the nerve root.Results The operation was completed smoothly in all the 65 patients without conversions to open surgery.The operation time was 136?21 min(range,110~170 min).The wound healed by first intention in all the patients.No nerve root injuries,intervertebral infection,or cerebrospinal fluid leakage were observed.A follow-up was carried out for 6~24 months(mean,14.5 months).According to the Nakai classification,excellent results were achieved in 42 patients,good in 18 patients,fair in 3,and poor in 2,the rate of excellent or good outcomes being 92.3%(60/65).Conclusions Microendoscopic lumbar discectomy with the preservation of the ligamentum flavum using the METRx is feasible.The preserved ligamentum flavum,as a good natural barrier,is helpful to prevent epidural fibrosis.

Objective To summarize the perioperative complications of microendoscopic discectomy(MED)for lumbar disc herniation,and to discuss the therapeutic strategies for these complications.Methods From October 1999 to Decmeber 2006,1852 patients with lumbar disc herniation were treated by MED in our hospital,140 of them developed perioperative complications.The clinical data of these patients were analyzed.Results Hemorrhage from the vertebral venous plexus was found in 48 cases,among which,MED was completed after controlling the bleeding under an endoscope in 42 cases,open discectomy was carried out in the other 6.In 47 cases,the herniated disc was incorrectly localized,and the MED was completed after correcting the location and direction of the endoscope.Twenty-one cases developed rupture of the dura mater during the MED,2 of them were converted to open surgery.Thirteen patients had leakage of the nucleus pulpous,and received a second-stage MED to remove the spinal nucleus.Six patients developed nerve injury and recovered completely one month later.Intraspinal infection was found in 5 patients after the MED;one of them was cured by conservative therapy,and the other 4 recovered after receiving the evacuation of the intraspinal lesions.Conclusion Complications of MED for lumbar disc herniation can be prevented or reduced effectively by proper therapeutic strategies.

Objective To investigate the expressions and role of bone morphogenetic protein(BMP) 2,basic fibroblast growth factor(bFGF),Core-binding factor al(Cbfa1)in the process of pathological bone formation in ankylosing spondylitis.Methods The expressions of BMP-2,bFGF and Cbfa1 in the synovial tissues of AS patients'sacroiliac ioint were detected using in situ hybridization.They were compared with those of patients with hip replacement and the gray scale of cells was analyzed with image analysis.Results The positive expressions of BMP-2,bFGF and Cbfal in the synovial tissues of patients'sacroiliac joint with AS were stronger than those of the control group(P＜0.01).Conclusion BMP-2,bFGF and Cbfal are important factors in the process of pathological bone formation in patients with AS.They areclosely correlated with the process of bone formation in patients'sacroiliac ioint with AS.Reduction of the expressions of BMP-2,bFGF and Cbfa1 with AS can block the process of pathological bone formation.

Objective To investigate the predictors and characteristics of the surgical outcomes of lumbar discectomy. Methods A total of 204 patients undergoing lumbar discectomy in our hospital from 1985-2003 were selected. The data on the surgical outcomes were collected using questionnaire, communication, and clinical follow-up. The cases were divided into four groups according to the different postoperative time: 1-2, 2-4, 4-8 years, and more than 8 years. The correlated factors in surgical outcomes in the four groups were analyzed by multiple regression analysis. The predictors and characteristics of the surgical outcomes in the four groups were compared. Results The duration between symptom onset and operation was significantly associated with the surgical outcomes. There was no statistical difference in surgical outcomes between the four groups. Conclusion The surgical outcomes of lumbar discectomy are closely associated with the preoperative onset of symptoms and remain unchanged in 2 years after operation.

Objective To observe the effects of inducing ossification in necrotic femoral head by VEGF. Methods Healthy rabbits were lesioned into necrotic femoral head by liquid nitrogen and randomly assigned for AdhuVEGF_(121) gene transfection into the necrotic femoral head and AdTrackCMV transfection. The alkaline phosphatase (ALP) activity before transfection and day 1, week 1, 2, 4, 6, 8, 12 after transfection and the expression of collagen Ⅰ at week 2, 4, 8, 12 was examined by enzymology and immunohistochemical techniques. Results The ALP activity of the AdhuVEGF_(121) group was significantly higher than AdTrackCMV group (P

Objective To observe the role of vascular endothelium growth factor (VEGF) in promoting vascular reconstruction and bone repair in the necrotic region of femoral head in rabbits. Methods The femoral head necrosis model was made by liquid nitrogen frozen. The necrotic femoral head was transfected by adenovirus human VEGF121 (Ad-hVEGF121) to observe the bone formation in subchondral necrotic region by means of histological method, measure BMD value by SPA-2 analyser and measure bone trabecular morphology by image analysis. Results Revascularization level, bone formation rate, bone quality and quantity and mineralization level in subchondral necrotic region of gene transfection group were significantly higher than the control groups that had more subchondral bone resorption compared with gene transfection group. Conclusions VEGF may have effect in promoting bone formation and revascularization in subchondral necrotic region of femoral head, indirectly protecting the necrotic bone trabecula from being absorbed and avoiding descending of subchondral mechanics function.

[Objective]To complete comparison between anterior cervical surgery by microendoscopic and open operation,explore feasibility and efficacy of anterior cervical decompression,interbody fusion and fixation by microendoscopic surgery,and give preliminary clinical evaluation of mieroendoscopic surgery.[Method]In a retrospective study,46 patients underwent one level cervical surgery by anterior approach.23 patients(23~64 years,41.5 years in average)were treated with microendoscopic surgery as microendoscopic group.Under general anesthesia,a transverse incision(1.6 cm)was made at right side of neck.A tubular retractor was then inserted and fixed,and a specially designed endoscope was placed inside the tubular retractor.Discectomy and interbody fusion with insertion of Cage or/and plate fixation was performed by endoscope.At fracture and dislocation patient group,titanium Cage was used in 1 case,CBK in 1 case,plate in 5 cases.At cervical disc herniation patient group,titanium Cage was used in 2 cases,CBK in 12 cases,plate in 2 cases.During the same period,23 patients(25~68 years,46.5 years in average)were treated with open surgery as open group.A transverse incision(4～5 cm)was made by right route approach.Discectomy and interbody fusion with Cage or/and plate fixation was performed by general procedure.[Result]At microendoscopic group,23 cases were followed up from 10 to 22 months(16.5 months in average),and mean operative time were 95 minutes,mean blood loss 90 ml.For fracture and dislocation patients,by Frankels classification,2 cases with complete tetraplegia showed no improvement,2 cases with incomplete tetraplegia improved from grade C to grade D postoperatively,1 case upgraded from C to E.For cervical spondylotic myelopathy patients with disc herniation,according to Odoms scoring system,10 cases had excellent outcome,5 good,1 fair.At open group,23 cases were followed up from 8~21 months(15.2 months as average),and mean operative time was 95 minutes,mean blood loss 90 ml.By Frankels classification,2 cases with complete tetraplegia had no improvement,3 cases with incomplete tetraplegia improved from C to D,1 case from D to E.According to Odoms scoring system,8 patients suffering from cervical spondylotic myelopathy with disc herniation had excellent result,6 good,2 fair.[Conclusion]Compared with open surgery,microendoscopic surgery with endoscopic instrument and technique can be used for one level discectomy,interbody fusion and internal fixation,and offer a similar short-term good clinical outcome with minimal incision,less traumatic reaction and postoperative discomfort.

Objective To investigate the expressions of BMP-2 and bFGF in ankylosing spondylitis(AS)patients in active stage.Methods Five patients with active AS were admitted from July 2006 to March 2007,including 4 males and 1 female,with average age of 31.4 years.Five patients with pelvic fracture served as control,including 3 males and 2 females,with average age of 34.5 years.Using immunohistochemistry,the expressions of BMP-2 and bFGF were detected in the frozen synovial tissues of cacroiliac joint in active AS patients and in the pelvic fracture patients,and the results were compared by analyzing the gray scale of the pictures.Results The positive expressions of BMP-2 and bFGF in the synovial tissues of cacroiliac joint in the patients with active AS were stronger than those in pelvic fracture patients(P