Objectives:To assess the midterm clinical outcomes after decompression and dynamic stabiliza-tion(Dynesys system)in multi-segmental lumbar spinal stenosis.Methods:The clinical data of 59 patients with lumbar spinal stenosis treatedwith decompression and 3 or more segments dynamic stabilization in our hospital from March 2010 to June 2015 were retrospectively reviewed.There were 28 males and 31 females,with an average age of 67.6±8.9 years(49-80 years).The operative time,blood loss and complications of the patients were collected.Before operation,at 3 months after surgery and final follow-up,visual analog scale(VAS)was used to assess the pain status of low back and leg,and Oswestry disability index(ODD was adopt-ed for functional evaluation,and also lumbar lordosis,range of motions(ROMs)of fixed segments and the first upper adjacent segment were evaluated with X-ray examination in the mean time,and the retention of ROM of the fixed segments was also calculated.Results:3 segmental Dynesys dynamic stabilizations were per-formed in 44 patients,4 segmental dynamic stabilizations were in 13 paticnts,5 segmental stabilizations were in 2 patients.The operative time was 259±58min,and the average blood loss was 593±296mL.The mean follow-up period was 7.2±1.3 years(range 5-9 years).The VAS scores and ODI at 3 months after operation improved significantly compared with those preoperatively(P＜0.05).At final follow-up,loosening was observed in 6 screws in 4 patients,who were asymptomatic;Wound infection developed in 1 patient at 34 months after surgery,which was cured by puncture pumping pus,irrigation and antibiotics for 4 weeks;None of the patients underwent revision surgery.At final follow-up,the ROM of the fixed segments was 13.1°±4.7°,which on average retained 43.8％of the preoperative ROM(28.9°±8.1°),and the ROM of the adjacent upper segement,and lumbar lordosis were preserved compared with before operation with no statistical difference(P＞0.05).Conclusions:Decompression and dynamic stabilization with Dynesys system was a safe and effective treatment in patients with multi-segmental lumbar spinal stenosis,which preserves lumbar activities with minor injury.

In the early stages of type 2 diabetes,inducing remission of hyperglycemia has become a global hotspot in the field of diabetes management.In recent years,scholars from both domestic and international commu-nities have established several remission intervention methods,including short-term intensive insulin therapy,life-style intervention,and metabolic surgery.They have also proposed theories such as beta-cell dedifferentiation and liver-pancreas"twin cycle"hypothesis,which have accelerated the growth of clinical and research information in this field.This review summarizes the clinical evidence,basic mechanisms,applicable populations,and exacutive principle points in the field of diabetes remission,with the aim of deepening the understanding of clinical practitio-ners about diabetes remission and laying the foundation for better practice and research in related fields.

The pelvic and acetabular fracture accounts for 3%-8% of all fractures, and is often accompanied with injuries to the bladder, rectum, important nerves and blood vessels. The fatality rate and disability rate are as high as 18%. The treatment of pelvic and acetabular fracture has experienced conservative treatment, surgical treatment and minimally invasive treatment. In recent years, minimally invasive surgery has been widely used in internal fixation of pelvic fracture. The anterior pelvic ring is an important tension bow of the pelvis. For unstable pelvic fracture, the anterior pelvic ring fracture accounts for almost 3/4. The authors review several minimally invasive surgical techniques for anterior pelvic ring fracture, including internal fixation (INFIX), anterior column channel screw internal fixation, pubic symphysis channel screw internal fixation and anterior ring bridge plate osteosynthesis, so as to provide a reference for choice of clinical treatment methods.

Objective:To compare the clinical effects of discectomy combined with transpedicular dynamic stabilization and transforaminal lumbar interbody fusion (TLIF) in treating single-level lumbar disc herniation.Methods:From November 2012 to November 2015, a total of 96 patients with single-level lumbar disc herniation (disc height decreased more than 1/3, the width of the basilar part of the herniated disc >6 mm, massive disc herniation or Modic type I endplate changes) treated by discectomy combined with Dynesys dynamic stabilization (Dynesys group, n=48) or TLIF (fusion group, n=48) were enrolled. Clinical assessments included operation duration, intraoperative blood loss, MacNab score, visual analogue scale (VAS), Oswestry disability index (ODI) and rate of complications. Radiographs were evaluated for lumbar mobility, intervertebral height, etc. Results:A total of 86 patients were included in the final analysis (44 in Dynesys group and 42 in fusion group) and were evaluated after 5 years follow-up. The operation duration of Dynesys group (159.61±37.29 min) was less than that of the fusion group (177.42±39.90 min) significantly ( t=2.140, P=0.035). Intraoperative blood loss in Dynesys group (151.78±50.88 ml) was less than that in fusion group (197.74±76.55 ml) with significant difference ( t=3.293, P=0.001). At 5 years follow-up, there were 2 cases with screw loosening and 5 cases with adjacent segmental degeneration in Dynesys group without symptom. In fusion group, there were 12 cases with adjacent segmental degeneration and two of them with symptom. There were significant differences in the incidence of adjacent segment degeneration between the two groups ( χ2=4.012, P=0.045). According to the MacNab criteria, excellent or good cases accounted for 95% in Dynesys group and 93% in fusion group without significant differences ( Z=0.425, P=0.671). VAS back, VAS leg and ODI scores were improved significantly in both groups after 2 years and 5 years ( P<0.05). However, there were no significant differences between the two groups ( P<0.05). The activity of the surgical segment was 4.59°±0.48° in Dynesys group and 1.00°±0.42° in fusion group at 5 years after surgery. The height of intervertebral space in Dynesys group decreased from 11.19±2.07 mm before surgery to 9.98±2.02 mm at 2 years after surgery and to 9.86±1.64 mm at 5 years after surgery ( F=6.462, P=0.002). However, there was no statistically significant difference between the 2 and 5 years follow-up ( q=0.415, P>0.05). At 5 years after surgery, the activity of the first proximal segment in the two groups was 9.74°±3.29° and 11.69°±3.89°, respectively ( t=2.514, P=0.014). Conclusion:Both discectomy combined with dynamic stabilization and TLIF can achieve satisfied clinical effects in treating single-level lumbar disc herniation. Dynamic stabilization preserves the intervertebral activity of surgical segments and results in a lower incidence of adjacent segment degeneration compared with that in fusion surgery. Furthermore, discectomy combined with dynamic stabilization is a less invasive intervention with shorter operation duration and less blood loss compared with TLIF.

Objective:To investigate the clinical features and treatment strategies of infection after lumbar transpedicular dynamic stabilization.Methods:A total of 1 623 cases with lumbar transpedicular dynamic stabilization conducted from January 2010 to June 2020 were retrospectively analyzed, including 854 males and 769 females and aged 47.56±12.76 years old. There were 1 150 cases with Dynesys fixation, 235 cases with K-Rod, 181 cases with Isobar, 52 cases with Fule and 5 cases with Waveflex. The primary diseases were as following, 984 cases (60.63%) with lumbar disc herniation, 280 cases (17.25%) with lumbar spinal stenosis, 174 cases (10.72%) with lumbar spondylolisthesis, 98 cases (6.04%) with lumbar degenerative scoliosis and 87 cases (5.36%) with discogenic low back pain. Some baseline indicators, such as the overall incidence of infection, the age, gender, smoking, drinking, diagnosis, previous operation history, concomitant disease, the number of fenestration, the number of discectomy, the number of fixed segments, operation duration, blood loss, blood transfusion, the number of the dura mater rupture, postoperative infection duration from primary operation, inflammation indicators (leukocytes, neutrophils, C-reactive protein, erythrocyte sedimentation rate and procalcitonin) of the infected patients, were recorded. According to the time when the infection occurred, the cases were divided into the early infection group (within 3 months after surgery) and the late infection group (more than 3 months after surgery). The clinical indicators and treatment strategies were compared between the two groups.Results:The overall infection rate was 1.66% (27/1 623), including 2.17% (25/1 150) in Dynesys fixation, 1.92% (1/52) in Fule fixation and 0.55% (1/181) in Isobar fixation. The follow-up duration was 51.89±32.55 months. The number of fenestrations was 1(1, 2). The number of discectomy was 1(1, 2), and that of fixed segments was 2(1, 3). The operation duration was 186.30±81.33 minutes, with the blood loss 200 (200, 500) ml and the blood transfusion volume 0(0, 345) ml. There was 1 case of cerebrospinal fluid leakage in early infection group. Thirteen cases of pathogenic bacteria were identified, included 5 cases of Staphylococcus epidermidis, 2 cases of Staphylococcus aureus and 1 case each of Salmonella, Escherichia coli, Pseudomonas aeruginosa, Enterobacter aerogenes, Acinetobacter baumannii, and Streptococcus lactis. A total of 21 patients underwent secondary surgery, including 10 cases of debridement and suturing, 2 cases of internal fixation replacement and 9 cases of internal fixation removal. The other 4 cases underwent puncture and irrigation, while 2 cases received only antibiotic treatment. There were 16 cases with early infection and 11 cases with late infection. There were no significant differences between the two groups in the number of fenestrations, discectomy, operation duration, blood loss, and blood transfusion ( P>0.05). The inflammation indexes of early infection group were higher than those of late infection group with significant difference ( P<0.05), except for procalcitonin. The detection rates of pathogenic bacteria in early and late infection group were 62.5% (10/16) and 27.3% (3/11), respectively. The main infection sites in early infection group were the incision (50.0%, 8/16) and around the internal fixation (18.8%, 3/16). However, the main infection sites in late infection group were around the internal fixation (90.9%, 10/11). In the early infection group, the main treatments including debridement and suturing were conducted in 9 cases, puncturing in 2 cases and internal fixation replacement in 2 cases. In the late infection group, internal fixation removal was performed in 8 cases and puncturing in 2 cases. Conclusion:The overall infection rate after lumbar transpedicular dynamic stabilization was 1.66%. The incidence of early infection was 0.99%, while that of late infection was 0.68%. The incidence of Dynesys fixation was 2.17%. In early infection, the internal fixation could be retained through some treatments as debridement and internal fixation replacement. In most late infection cases, removal of the internal fixation could be helpful to control the infection.

A 22-year-old female patient presented with skin flushing in the bilateral legs for 4 years, which gradually spread throughout the whole lower limbs and forearms 6 months ago. Skin examination showed diffuse flushing and dilated capillaries in the lower limbs and both forearms, and the flushing faded after a press. Histopathological examination of the skin lesion on the leg showed hyperkeratosis in a basket-like shape, increased pigmentation in the basal layer, infiltration of the superficial dermis with scattered lymphocytes, with no obvious red blood cell overflow; periodic acid-Schiff staining showed thickened and homogeneous deposits around the blood vessels; immunohistochemical staining showed thickened blood vessel walls and positive staining for type Ⅳ collagen. Diagnosis: cutaneous collagenous vasculopathy.

Acute traumatic cervical spinal cord injury (TCSCI) is one of the most common severe injuries, and is often accompanied by complications like respiratory infection due to different degrees of paralysis of respiratory muscles, decreased cough function, increased bronchial secretions and bronchial spasm, which seriously affects the respiratory function recovery and enhances mortality rate. The authors review the respiratory management in patients with TCSCI from mechanical ventilation, tracheotomy, oxygen therapy, aerosolized inhalation, assisted sputum extraction, and respiratory function training, in order to provide a reference for clinical nursing work and improve the treatment effect.

Objective To introduce extrapedicular infiltration anesthesia as an improved method of local anesthesia which applied to unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty.Methods From March 2015 to March 2016,20 patients in our hospital received percutaneous vertebroplasty or percutaneous kyphoplasty with 1％ lidocaine local infiltration anesthesia and extrapedicular infiltration anesthesia.The visual analogue score of patients during the operation and whether they needed additional sedative anesthesia were evaluated.The anaesthetic effect of nerve root block was observed.Results The visual analogue score of all the patients ranged from 1 point to 3 point,averagely (2.5 ± 0.7) point.Among the 20 patients,there were 2 cases of 1 point,7 cases of 2 point and 11 cases of 3 point.No patients required additional sedative anesthesia,and no nerve root block effects were observed.Conclusion Extrapedicular infiltration anesthesia provides good local anesthetic effects without significant complications,which deserved further use in unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty.

tomography angiography ( CTA) and T12-S1 vertebral computed tomography three-dimensional reconstruction were selected .The operative win-dows of L1 ~L2 OLIF were observed:the vascular window ,bare window ,psoas major window ,ideal operative window and actual operative win-dow.The operative windows ’ percentage accounted for ideal operative window were calculated ,the actual operative window based on an actual operative window of <1 cm,≥1 cm were statistically analyzed ,and the positions of the left renal artery and renal vein in front of operative window of L1 ~L2 OLIF were observed.Results The actual operative window was <1 cm in 2 cases (3.3%) and ≥1 cm in 58 cases (96.7%).In 58 cases,the difference was significant(P=0.008) in gender and men were more than women.The vascular window,bare win-dow and psoas major window accounted for the ideal operative window by 45%,43%and 12%,respectively ,and the actual operative window accounted for the ideal operative window by 55%.The left renal artery and renal vein's walking planes were at between the middle 1/3 of L1 to up 1/3 of L2 .There were 31 cases (51.7%) of the left renal artery being behind the left renal vein .Conclusion The regional anatomy of the operative window of L1 ~L2 OLIF has its own peculiarities,and not all L1 ~L2 levels are suitable for OLIF.The left renal vessels’ walk-ing planes were in front of L 1 ~L2 .Before L1 ~L2 OLIF surgery,surgeons should analyze the imaging anatomimy through imaging .

Objective To evaluate the effect of selenomethionine (Se-Met) against ultraviolet B (UVB)-induced oxidative damage to human HaCaT keratinocytes,and to explore its possible mechanisms.Methods Cultured HaCaT cells were divided into several groups:normal control group receiving no treatment,Se-Met groups treated with Se-Met at concentrations of 1,10,50,100,200 nmol/L and 1 μmol/L for 24 hours respectively,UVB groups irradiated with UVB of 30,60 and 90 mJ/cm2 respectively,Se-Met + UVB groups treated with Se-Met at concentrations of 1,10,50,100,200 nmol/L and 1 μmol/L for 24 hours firstly,then irradiated with UVB of 30,60 and 90 mJ/cm2 respectively.Subsequently,methyl thiazolyl tetrazolium (MTT) assay was performed to estimate cellular proliferative activity,flow cytometry to detect cell apoptosis,colorimetry to evaluate superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities and to determine malondialdehyde (MDA) levels.Statistical analysis was carried out by using factorial design analysis of variance (ANOVA),one-way ANOVA and least significant difference (LSD) test.Results Factorial design ANOVA showed that UVB radiation had an inhibitory effect on the proliferative activity of HaCaT cells (F =128.04,P ＜ 0.05),which significantly decreased along with the increase of UVB doses,with significant differences between the three UVB groups (P ＜ 0.05).Se-Met pretreatment also affected cellular proliferative activity (F =5.95,P ＜ 0.05),which was significantly increased in Se-Met (10 nmol/L-1 μmol/L) + UVB groups compared with the UVB groups at corresponding doses (all P ＜ 0.05).There was no significant interaction effect on cellular proliferative activity between UVB radiation and Se-Met pretreatment (F =1.65,P ＞ 0.05).The apoptosis rate of HaCaT cells in the 30-mJ/cm2 UVB group was 31.9％ ± 2.67％,significantly higher than that in the normal control group (4.1％ ± 0.67％,P＜ 0.05) and in the 10-,50-,100-,200-nmol/L and 1-μmol/L Se-Met + 30-mJ/cm2 UVB groups (21.9％ ± 3.72％,17.2％ ± 1.67％,4.6％ ±-0.85％,7.5％ ± 1.86％ and 13.5％ ± 1.95％ respectively,all P ＜ 0.05).Similarly,SOD and GSH-Px activities were significantly weaker (both P ＜ 0.05),while MDA levels were higher (all P ＜ 0.05) in the 30-mJ/cm2 UVB group than in the normal control group;however,there was a significant increase in SOD and GSH-Px activities but a decrease in MDA levels in the Se-Met (10 nmol/L-1 μmol/L) + 30-mJ/cm2 UVB groups compared with the 30-mJ/cm2 UVB group (all P ＜ 0.05).Conclusions Se-Met can reduce UVB-induced oxidative damage to HaCaT cells,likely by enhancing antioxidase activity and decreasing oxygen radicals.