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 and efficiency of treatment of lumbar degenerative disease with unilateral decompression,interbody fusion and percutaneous pedicle screw fixation under endoscopic system.[Method]From June 2004 to March 2007,20 patients underwent minimally invasive transforaminal lumbar interbody fusion(TLIF) or posterior lumbar interbody interbody fusion(PLIF),which consisted of 11 male and 9 female patients.The mean age was 46.2 years(range,31～70),and the preoperative diagnosis consisted of postoperative recurrent lumbar disc herniation(n =8),far lateral lumbar disc herniation(n =4),spinal stenosis(n = 3),lumbar instability(n = 3),and discogenic lumbar pain(n =2).One-level decompression and intebody fusion with unilateral pedicle screw fixation under endoscopic system was performed in all of cases(12 at L4、5,and 8 at L5S1).A paramedian,muscle-sparing approach was performed through a tubular retractor docked unilaterally on the facet joint.A total facetectomy was then conducted,exposing and removing the disc(TLIF),or microendoscopic discectomy(MED) was performed(PLIF).The intervertebral space preparation were completed through the X-tube or METRx system.Interbody fusion was achieved with autograft bone and interbody cages.Unilateral pedicle screw-rod placement was accomplished.[Result]There was no conversions to open surgery.Operative time averaged 115 minutes(range,100～165 min).Blood loss averaged 130 ml(range,50～180 ml).Mean length of postoperative hospital stay was 11 days(range,7～15 days).All patients presenting with preoperative low back pain and /or lower extremity radicular pain(n= 20) had resolution of symptoms postoperatively.Complications included two cases of new radiculopathy postoperatively(one from graft dislodgement,the other from hematoma formation).Twenty patients were followed up 10～39 months(average 21.6 months).The preoperative,1 month postoperative and last follow-up Oswestry Disability Index(ODI scores were 42.05+8.36,21.33?6.37 and 12.31?3.75 separately(P

Objective To investigate the expression of β-arrestin2 and microtubule-associated pro-tein light chain(LC)3 in renal of rat with acute renal ischemia reperfusion injury,and to analyze the relation-ship between them and renal injury. Methods Fifty-four male SD rat(3-4 weeks old) were randomly divid-ed into three groups:control group,sham group,acute ischemic reperfusion injury group. We established the acute renal ischemia reperfusion injury model through removing the right kidney and clamping the left renal for 45 minutes with noninvasive arterial clip. We obtained the kidney and blood samples respectively at 12 h, 24 h,36 h,48 h,72 h,96 h after the surgery. Expressions ofβ-arrestin2 and LC3 protein were detected by the immunohistochemistry method and Western blot method. The renal function and morphological changes were assessed. Results Compared with control group and sham group,the serum creatinine and kidney pathologi-cal grading of acute ischemia reperfusion injury group obviously rised. The kidney injury was the most serious at the 24 h after acute ischemic reperfusion injury. The expressions of β-arrestin2 and LC3 were little in the control group and sham group. However,the expressions of these two indicators were obviously higher and reached the peak at the 12 h after acute ischemia reperfusion injury. All these results suggested that the chan-ges of these two indicators were anterior to the histopathological changes. The expressions ofβ-arrestin 2 and LC3 protein were in positive correlation with the kidney injury(r=0. 821,P<0. 05;r=0. 913,P<0. 05). Conclusion In the acute renal ischemia-reperfusion injury,β-arrestin2 may be as a kind of upstream regula-tory protein involving in the kidney pathological process through the regulation of the autophagy.

Objective To investigate the protective mechanism of 7-nitro indazole (7-NI) in neonatal rats with hypoxic-ischemic brain damage. Methods Seventy-two Wistar rats of 7-day-old were randomly divided into the sham-operation、HIBD and 7-NI treated group. The HIBD models were established in 7-NI treated and HIBD groups.7-NI (100 mg/kg) or peanut oil (10 ml/kg) was injected intraperitoneally 0.5 h before hypoxia in 7-NI treated group or HIBD group. NOS,NO,SOD and MDA were examined at different time (1 h、2 h、6 h、8 h). Terminal deoxynucleotidyl transferase mediated dUTP-biotin nick end labeling(TUNEL) method was used to detect neuronal apoptosis. Results NOS and NO level of HIBD group at different time were significantly higher than that of the sham-operation group [NOS:1 h (3.345?0.367)U/mg, 8 h (4.469?0.275) U/mg vs (1.555?0.223) U/mg; NO: 1 h (2.419?0.254) ?mol/g, 8 h (3.556?0.309) ?mol/g vs (0.749?0.135) ?mol/g, 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 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 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 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.