Objective To study the characteristics of spinal fractures in ankylosing spondylitis(AS) in order to provide data in its diagnosis and treatment. Methods 19 cases of concomitant spinal fractures following AS, admitted in our hospital between January 1994 and October 2001, were studied retrospectively. Examination of AS, including A-P and lateral X-ray films of bilateral sacroiliac joint, HLA-B27, rheumatoid test and ESR were accomplished in all patients. MRI and CT scan were taken in 12 cases. 4 cases of thoracolumbar stress fracture treated surgically were conformed to pathological examination. 2 cases received preoperative puncture biopsy under CT guidance. In the group, there were 18 males and 1 female aging from 31 to 69 years with an average of 52.6 years. Results All of 19 cases were consistent with the diagnostic standards of AS. 17 of the patients prior to spinal fracture had a history of AS with duration of mean 20.6 years ranging from 8 to 37 years. All of 19 patients had round-backed deformity of different extent. Of 19 patients, 15 cases had a traumatic history. Falls while standing and walking were the cause of injury in 9 patients. The mechanism of injury appeared to be hyperextension in 7. 11 patients had the cervical fracture, and 8 had the thoracolumbar fracture. Of the patients with cervical fracture, 10 patients were due to shearing force, 9 of whom were located at C5-C7. In patients with thoracolumbar injury, stress fractures were seen in 7 patients, all of seven fractures occurred at T10-L2. Fracture through ankylosed disc was seen in 12 and vertebral body in 7. 16 of the 19 patients sustained fractures through three columns of the spine. 5 patients were associated with dislocation. 9 patients had spinal cord injury, 8 of whom were cervical fracture. The period from the injury to the diagnosis ranged from 10 hours to 7 months (mean 29.6 days). Conclusion Spinal fractures in AS can result from a mild trauma, and are associated with a high rate of neurological injury. Most frequent mechanism of the injury is hyperextension. Shearing fracture usually occurs at the lower cervical spine and stress fracture at thoracolumbar spine. Most of the fractures involve three columns of spine; and corresponding dislocation is common. The common fracture line is through the disc space. Delay in diagnosis is not rare.

Objective To investigate the effects of different magnitudes of mechanical stress on human interverte-bral disc degeneration. Methods The human intervertebral disc cells were subjected to different magnitudes of mechanical stress (0, 6%, 12%, or 18%elongation) for 24 h using a Flexercell Strain Unit. The mRNA expressions of anabolic genes (col-lagen-1A1, collagen-2A1, aggrecan and versican) and catabolic genes (MMP-3, MMP-13, ADAMTS-4 and ADAMTS-5) were examined by real-time PCR and Western blot methods. Results The expression levels of collagen-1A1 and collagen-2A1 were increased at 12%of mechanical stress, and collagen-2A1 was decreased at 18%of mechanical stress compared with those of control. The mRNA expressions of catabolic genes, MMP-13 and ADAMTS-5, were increased at 12%and 18%of mechanical stress than those of control. The mechanical stretch induced a magnitude-dependent increase in ADAMTS-4 synthesis, which was finely tuned by stretching-triggered activation of distinct mitogen-activated protein kinase cascades. Specifically, an ERK1/2 specific inhibitor, U0126, significantly inhibited the stretching-induced ADAMTS-4 expression, whereas the inhibitors of p38 and JNK, SP6000125 and SB203580, showed only slightly effect on the stretching-induced ADAMTS-4 expression. Conclusion The different magnitudes of mechanical stretch exhibited different effects on the bio-logical behavior of intervertebral disc cells, which profoundly affects the intervertebral disc degeneration.

Objective To investigate the safety and efficiency of thoracic laminectomy with dekyphosis for thoracic myelopathy due to multi-segmental ossification of the posterior ligaments.Methods The clinical data of five cases of thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments who were surgically treated in our hospital between August 2012 and March 2013 were retrospectively analyzed,among which two were male and the other three were female,with an average age of 52 (range,45-56) years old.The pre-operative duration ranged from 2 months to 6 years.All five cases were suffering from progressive bilateral partial paraplegia with an average preoperative JOA score 3.8 (range,3-6),an average segment-number of ossification of the posterior ligaments 7.6 (range,5-10),and also an average segment-number of 5.0 (range,2-10) ossification of the ligamentum flavum.All the five cases showed different kyphosis at the stenotic area of thoracic spine,with an average kyphotic angle (Cobb) of 35.8° (range,22°-56°).Their pre-operative Japanese Orthopaedic Association score (JOA) was 3.8 averagely (range,3-6).Clinical features,operation time,blood loss,perioperative complications and postoperative outcome were recorded.Results The segment number of laminectomy of these five cases was 8.2 averagely.The segment number of dekyphosis was 2 for 2 cases and 1 for the other 3 cases,with a average dekyphotic degree of 7.8° (range,2°-15°).The average operation time was 6.3 hours (range,5.5-7.0 hours) and the average blood loss was 3900 ml.The perioperative complications included cerebrospinal fluid leakage in 4 cases who were treated conservatively,and epidural hematoma in 1 case who underwent reoperation for removing the hematoma.All cases were followed up for 21 to 27 months,and their average final JOA score was 10,with an average recovery rate of 85.6％,and a rate of excellent or good was 100％ by the modified Epstein standard.Conclusion The result of thoracic laminectomy combined with dekyphosis for thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments is quite satisfying,however this procedure is demanding with a long operation time,a huge blood loss and a high complication rate.

Objective To evaluate transurethral fulguration with intravesical instillation of heparin and alkalinized lidocaine for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS).Methods Data from the chnical records of 31 patients (30 female and 1 male) with IC/BPS were analyzed retrospectively.Transurethral fulguration and biopsy were performed.Intravesical instillation of heparin and alkalinized lidocaine (25 000 units of hepmin,10 mL of 2％ lidocaine,and 5 mL of 5％ sodium bicarbonate) was administered weekly for 8 weeks.Thereafter,intmvesical instillation treatment was administered twice a month.The interstitial cystitis symptom index and problem index (O'Leary-Sant index),visual analog scale score for pain,quality-of-life index,voiding frequency,bladder capacity,and side effects of intravesical instillation were recorded preoperatively and at the first and sixth month follow-ups postoperatively.Results The follow-up period was 6 to 24 months.The interstitial cystitis symptom index and problem index,visual analog scale score for pain,quality-of-life index,daily voiding time,and maximal bladder volume improved significantly in 28 cases (90.32％;P ＜ 0.01),and no significant adverse effects were observed.Two patients underwent cystectomy,and the symptoms disappeared after the operation.Carcinoma in situ was detected on histopathological examination in one patient.Conclusion Transurethral fulguration with intravesical instillation of heparin and alkalinized lidocaine is a safe and effective therapy for IC/BPS.

Objective To evaluate the feasibility,safety and efficacy of surgical treatment of the thoracic and thoracolumbar disc herniations through the posterior far lateral approach,Methods From April 2005 to June 2010,24 consecutive patients with thoracic or thoracolumbar disc herniations were treated surgically,using the posterior far lateral approach.There were 15 males and 9 females with the mean age of 53.6 years old(range,25-69 years).The levels of herniated discs were located in T4-s,T5-6,T6-7 for 1 case,in T9-10 for 1 case,in T10-11 for 2 cases,in T10-11,T11-12,T12L1 for 1 case,in T11-12 for 3 eases,in T11-12,T12L1 for 3 cases,in T12L1 for 4 cases,in T12L1,L1-2 for 3 cases,and in L1-2 for 6 eases.There were one level disc herniation in 16 cases,two levels disc herniation in 6 cases and three levels disc herniation in 2 cases.16 out of 24 cases had "bony protrusions",including bony separation of the endplate,bony spur,disc calcification or OPLL.The average preoperative Cobb angle of localized kyphosis was 10.5°.According to the Frankel grading system,5 cases were classified as C,16 as D,and 3 as E,preoperatively.Results Average operation time was 3.5 h(2.0-4.5 h),and mean blood loss was 800 ml(300-4000 ml).Postoperative localized kyphosis was an average of 4.6°,with average correction rate of 56.2%.24 cases were followed up for 1 to 62 months,with an average of 18 months.According to Japanese Orthopaedic Association(JOA)criteria system,there were 12 cases(50.0%)with excellent outcome,9 cases(37.5%)with good outcome,and 3 cases(12.5%)with fair outcome.The postoperative Frankel grading were C for 1 case,D for 2 cases,and E for 21 cases.There were no complications intraoperatively and postoperatively.The symptoms were improved in all patients.Conclusion By using "safe triangular zone" and dekyphosis stabilization,the posterior far lateral approach was a relatively safe,reliable,effective and better view surgical procedure for the treatment of the thoracic and thoracolumbar disc herniations.

Researches have shown that melatonin is neuroprotectant in ischemia/reperfusion-mediated injury. Although melatonin is known as an effective antioxidant, the mechanism of the protection cannot be explained merely by antioxidation. This study was devoted to explore other existing mechanisms by investigating whether melatonin protects ischemia/reperfusion-injured neurons through elevating autophagy, since autophagy has been frequently suggested to play a crucial role in neuron survival. To find it out, an ischemia/reperfusion model in N2a cells was established for examinations. The results showed that autophagy was significantly enhanced in N2a cells treated with melatonin at reperfusion onset following ischemia and greatly promoted cell survival, while autophagy blockage by 3-MA led to the shortened N2a cell survival as assessed by MTT, transmission electron microscopy, and laser confocal scanning microscopy. Besides, the protein levels of LC3II and Beclin1 were remarkably increased in ischemia/reperfusion-injured N2a in the presence of melatonin, whereas the expression of p-PKB, key kinase in PI3K/PKB signaling pathway, showed a decrease when compared with untreated subjects as accessed by immunoblotting. Taken together these data suggest that autophagy is possibly one of the mechanisms underlying neuroprotection of melatonin.

OBJECTIVETo provide reference for correct clinical treatment by summarizing the characteristics and surgical experience in spinal deformity of the upper thoracic (T(1)-T(4)) short angular kyphosis.

METHODSMedical history was taken in 15 cases are reviewed. The results of X-ray and MRI examinations were analyzed. The kyphotic angles were measured using the Cobb technique. All cases underwent the anterior spinal cord decompression, by posterolateral approach in 4 cases and posterior in 11 cases.

RESULTSKyphosis was congenital in 7 cases and due to tuberculosis approach in 8 was. The average age at deformity was first noted was 3.6 years in 7 congenital cases and 9.0 years in 8 tuberculosis cases. All cases had neurologic deficits. The mean kyphosis was 86.5 degrees (range, 45 - 100 degrees). The delay between first observation of the deformity and subsequent neurologic loss was 16.5 years and 18.1 years respectively. The operation failed in 1 case. 13 cases were followed up, with an average 42 months. Seven cases showed improvement, 2 no change and 4 deterioration in neurologic deficit.

CONCLUSIONSIn cases of or tuberculosis kyphosis, the usual time for kyphosis to occur is during the preadolescent growth spurt. Neurologic deficits may occur without treatment and will be always progressive. The result of operation is not satisfactory. Early diagnosis and adequate management of kyphosis will prevent progression and thus any possible spinal cord compression. Early fusion is usually necessary to control the kyphosis.

Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; diagnosis ; surgery ; Male ; Middle Aged ; Thoracic Vertebrae

STUDY DESIGN: A retrospective clinical review. PURPOSE: To investigate the difference in clinical manifestations and severity between polymicrobial and monomicrobial infections after spinal surgery. OVERVIEW OF LITERATURE: Surgical site infections (SSIs) after spinal surgery are a major diagnostic and therapeutic challenge for spinal surgeons. Polymicrobial infections after spinal surgery seem to result in poorer outcomes than monomicrobial infections because of complementary resistance to antibiotics. However, comparison of the clinical manifestations and severity between polymicrobial and monomicrobial infections are limited. METHODS: Sixty-seven patients with SSIs after spinal surgery were studied: 20 patients with polymicrobial infections and 47 with monomicrobial infections. Pathogenic bacteria identified were counted and classified. Age, sex, and body mass index were compared between the two groups to identify homogeneity. The groups were compared for clinical manifestations by surgical site, postoperative time to infection, infection site, incisional drainage, incisional swelling, incisional pain, neurological signs, temperature, white blood cell count, and the percentage of neutrophils. Finally, the groups were compared for severity by hospital stay, number of rehospitalizations, number of debridements, duration of antibiotics administration, number of antibiotics administered, and implant removal. RESULTS: Polymicrobial infections comprised 29.9% of SSIs after spinal surgery, and most polymicrobial infections (70.0%) were caused by two species of bacteria only. There was no difference between the groups in terms of clinical manifestations and severity. In total, 96 bacterial strains were isolated from the spinal wounds: 60 strains were gram-positive and 36 were gram-negative pathogenic bacteria. Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Enterobacter cloacae were cultured in order of the frequency of appearance. CONCLUSIONS: Most polymicrobial infections were caused by two bacterial species after spinal surgery. There was no difference in clinical manifestations or severity between polymicrobial and monomicrobial infections.
Anti-Bacterial Agents ; Bacteria ; Body Mass Index ; Coinfection ; Debridement ; Drainage ; Enterobacter cloacae ; Escherichia coli ; Humans ; Length of Stay ; Leukocyte Count ; Neutrophils ; Postoperative Complications ; Retrospective Studies* ; Spine ; Staphylococcus aureus ; Staphylococcus epidermidis ; Surgeons ; Surgical Wound Infection ; Wounds and Injuries

Objective: To examine the association of hyperglycemia and postoperative complications in non-diabetic patients underwent pancreaticoduodenectomy(PD). Methods: The clinical data of 209 non-diabetic patients who underwent PD from January 2012 to June 2018 at Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University and met the inclusion criteria were retrospectively analyzed. According to the diagnostic criteria of postoperative hyperglycemia, the patients were divided into postoperative hyperglycemia group (167 cases, 79.9%) and control group(42 cases, 20.1%). The propensity score matching(PSM) method was used to eliminate the difference between groups(caliper value=0.02; 38 cases in control group including 30 males and 8 females with age of 59.0 years; 38 cases in postoperative hyperglycemia group including 32 males and 6 females with age of 61.0 years; 37 cases of pancreatic head carcinoma, 30 cases of periampullary carcinoma and 9 cases of benign diseases). A comparative analysis was applied for preoperative data, surgical related indicators and postoperative complication rates.The receiver operating characteristic(ROC) curve was used to calculate the area under the curve(AUC) of blood glucose values on postoperative day 1,3 and 5(POD1, POD3, POD5), to determine the high-risk blood glucose cutoff value of complications and to evaluate its sensitivity and specificity for the prediction of postoperative complications. Results: Univariate analysis showed that the differences in gender, body mass index, preoperative blood glucose, and serum urea nitrogen levels were statistically significant before PSM.There was no significant difference in the preoperative data between the two groups after PSM. Compared with the control group, the incidence of postoperative pancreatic fistula (31.6% vs. 5.3%), abdominal infection(29.0% vs. 7.9%) and Clavien-Dindo Ⅲ-Ⅴ complications(31.6% vs.7.9%) were statistically different(χ²=7.092, P=0.008; χ²=4.290, P=0.038; χ²=5.316, P=0.021), respectively. According to the AUC on POD3, the blood glucose value≥8.860 mmol/L was an independent risk factor for pancreatic fistula with sensitivity of 58.3% and specificity of 76.9%, the blood glucose value ≥9.130 mmol/L was an independent risk factor for abdominal infection with sensitivity of 54.5% and specificity of 81.5% and the blood glucose value ≥7.685 mmol/L was independent risk factor of Clavien-Dindo Ⅲ-Ⅴcomplications with sensitivity of 75.0% and specificity of 57.7%. Conclusions Postoperative hyperglycemia in non-diabetic patients is associated with postoperative pancreatic fistula, abdominal infection, and Clavien-Dindo Ⅲ-Ⅴ complications.According to the early postoperative blood glucose value, the occurrence of postoperative pancreatic fistula, abdominal infection and Clavien-Dindo Ⅲ-Ⅴ complications can be effectively predicted.

Objective: To explore the relationship between procalcitonin (PCT), C-reactive protein (CRP) and blood glucose (BG) levels and postoperative pancreatic fistula (POPF) in non-diabetic patients after pancreaticoduodenectomy (PD), and evaluate the clinical value of early multi-indicators combined prediction of pancreatic fistula. Methods: The clinical data of 68 non-diabetic patients who underwent PD surgery from April 2016 to June 2018 in the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed, including 42 males and 26 females, with average age of 58 years, age range from 26 to 80 years. According to the diagnostic criteria of POPF, the patients were divided into the pancreatic fistula group (n=17) and the non-pancreatic fistula group (n=51). The surgical related indicators, health economic indicators and PCT, CRP, and BG levels on preoperative and postoperative day 1, 3 and 5(POD1, POD3, POD5) were compared between two groups. Multivariate logistic regression analysis was used to screen out independent risk factors associated with POPF, and a weighted predictive model (wScore M) for predicting pancreatic fistula in non-diabetic patients was established by combining independent risk factors. The receiver operating characteristic (ROC) curves of each independent risk factor and prediction model were plotted to determine the cutoff value, area under the ROC curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value, and individual risk factors were compared. And the predictive value of the multi-indicator combined prediction model. Results: Univariate analysis showed that the pathological types of the tumor, the tumor size, the blood glucose level of POD3, the PCT level of POD1, POD3, POD5 and the CRP level of POD3, POD5 were statistically different (P<0.05). Multivariate analysis showed that PCT (P=0.004), CRP (P=0.031), and BG (P=0.005) levels of POD3 were independent risk factors of POPF. The AUC of the ROC were 0.967, 0.692, and 0.698, respectively. The sensitivity were 0.588, 0.706, and 0.647, respectively. The specificities were 0.863, 0.686, and 0.765, respectively. The positive predictive values were 52.9%, 70.6%, and 64.7%, respectively. The negative predictive values were 88.2%, 70.6%, and 76.5%; the AUC of the wScore M ROC curve was 0.877, the sensitivity was 0.706, the specificity was 0.863, the positive predictive value was 70.6%, and the negative predictive value was 86.3%. Compared with the non-pancreatic fistula group, the patients of the pancreatic fistula group with pancreatic fistula complications had prolonged hospitalization time and increased the total hospitalization cost, which were statistically different (P=0.039, 0.010). Conclusion PCT, CRP and BG are independent risk factors for POPF, and early combined prediction of multiple indicators (POD3)has good predictive value, which has significant clinical reference for optimal and effective interventions at early stage.