OBJECTIVE: To explore the anatomical parameters of the cervical uncinate process "inflection point" through cervical CT angiography (CTA) and MRI measurements, offering a reliable and safe anatomical landmark for anterior cervical decompression surgery. METHODS: A retrospective analysis was conducted on the cervical CTA and MRI imaging data of normal adults who met the selection criteria between January 2020 and January 2024. The CTA dataset included 326 cases, with 200 males and 126 females, aged 22-55 years (mean, 46.7 years). The MRI dataset included 300 cases, with 200 males and 100 females, aged 18-55 years (mean, 43.7 years). Based on the CTA data, three-dimensional models of C ₃-C ₇ were constructed, and the following measurements were obtained from the superior view: uncinate process "inflection point" to vertebral artery distance (UIVD), uncinate process tip to vertebral artery distance (UTVD), uncinate process "inflection point" to "inflection point" distance (UID), uncinate process long-axis to sagittal angle (ULSA), and uncinate process "inflection point" to transverse foramen-sagittal angle (UITSA). From the anterior view, the anterior uncinate process to sagittal angle (AUSA) was measured. From the posterior view, the posterior uncinate process to sagittal angle (PUSA) was measured. Based on the MRI data, uncinate process "inflection point" to dural sac distance (UIDD) and dural sac width (DSW) were measured. The trends in measurement parameters of C ₃-C ₇ were observed, and the differences in measurement parameters between genders and between the left and right sides of the same segment were compared, as well as the difference in UID and DSW within the same segment was compared. RESULTS: The measurement parameters from C ₃ to C ₇ in the CTA data showed a general increasing trend, with no significant difference between the left and right sides within the same segment ( P>0.05). The UIVD, UTVD, and UID were greater in males than in females, with significant differences observed in the UIVD and UTVD at C ₃ and C ₆ and UID at C ₃, C ₆, and C ₇ ( P<0.05). The MRI measured DSW showed a general increasing trend from C ₃ to C ₇, and the DSW at C ₆ was greater in females than in males, with a significant difference ( P<0.05). The UIDD showed a gradual decreasing trend, with the smallest value at C ₆. There was no significant difference between males and females or between the left and right sides within the same segment ( P>0.05). The UID was greater than the DSW at C ₃-C ₇, and the differences were significant ( P<0.05). CONCLUSION The uncinate process "inflection point" is a constant anatomical structure located at the anteromedial aspect of the uncinate process tip and laterally to the dural sac. It maintains a certain safe distance from the vertebral artery. As a decompression landmark in anterior cervical spine surgery, it not only ensures surgical safety but also guarantees complete decompression.
Humans ; Adult ; Male ; Female ; Middle Aged ; Retrospective Studies ; Cervical Vertebrae/surgery* ; Magnetic Resonance Imaging ; Decompression, Surgical/methods* ; Young Adult ; Adolescent ; Computed Tomography Angiography ; Imaging, Three-Dimensional ; Vertebral Artery/anatomy & histology* ; Anatomic Landmarks/diagnostic imaging*

BACKGROUND:For thoracolumbar spine fractures with developmental stenosis of the vertebral arch,accurate nail placement is difficult using traditional fluoroscopy-assisted techniques.O-arm navigation assistance systems offer higher precision in general vertebral arch nail placement,but there is scarce literature on the application of O-arm navigation-assisted nail placement in thoracolumbar spine fractures with developmental stenosis of the vertebral arch both domestically and abroad. OBJECTIVE:To explore the accuracy of percutaneous vertebral arch nail placement assisted by O-arm navigation in patients with thoracolumbar spine fractures complicated by developmental stenosis of the vertebral arch. METHODS:A retrospective analysis was conducted on 53 patients who underwent percutaneous vertebral arch screw fixation surgery at Department of Orthopedics,General Hospital of Central Theater Command of PLA for thoracolumbar spine fractures complicated by developmental stenosis of the vertebral arch from January 2021 to March 2023.Totally 208 cases of vertebral arch developmental stenosis were found(cases with multiple vertebral arch developmental stenosis were counted separately).Based on the surgical approach,the patients were divided into two groups:O-arm navigation group(n=98)and C-arm fluoroscopy group(n=110).Postoperative imaging data were compared between the two groups,including anatomical perforation score,functional perforation score,actual vs.expected nail trajectory in the horizontal plane,and sagittal plane angle differences. RESULTS AND CONCLUSION:(1)There was no significant difference in the narrowest width of the pedicle isthmus(pow)between the two groups of patients(P>0.05).The proportions of different degrees of narrowing(mild:6 mm≤pow<7 mm,moderate:5 mm≤pow<6 mm,severe:pow<5 mm)were also not significantly different between the two groups(P>0.05).(2)The overall grade and scores of anatomical perforation and functional perforation were lower in the O-arm group compared to the C-arm group,and these differences were statistically significant(P<0.001).In terms of the angular deviation between the actual and planned screw trajectories,the O-arm group had smaller deviations,and these differences were statistically significant(P<0.05).(3)In the mild and moderate narrowing groups,the O-arm group showed significant advantages in anatomical perforation,functional perforation,and angular deviation between actual and planned screw trajectories,and these differences were statistically significant(P<0.001).(4)The O-arm group demonstrated better performance in anatomical perforation and functional perforation,especially in the T12-L2 segment,with more significant advantages.Additionally,the O-arm group had better angular deviations in actual and planned screw trajectories in all segments compared to the C-arm group.(5)Therefore,the use of O-arm navigation-assisted percutaneous screw placement for the treatment of thoracolumbar fractures with developmental pedicle isthmal narrowing provides higher accuracy and safer surgery.

Objective To investigate the protective effect and mechanism of nicorandil on lipopolysac-charide(LPS)-induced human microvascular endothelial cells(HPMVECs)injury based on BMP9/BMPR2/SMAD pathway and its mechanism.Methods The HPMVECs injury model induced by LPS(100 ng/mL)was established.The normal cultured HPMVECs were set as the NC group,and other model cells were set as the model group(LPS group),low,medium and high concentrations nicorandil groups(nicorandil 50,100,200μmol/L),si-NC+high nicorandil group,and si-BMP9+high nicorandil group.MTT assay was used to detect the cell proliferation activity;the apoptosis and intracellular ROS level were detected by flow cytometry;the levels of MDA,SOD and CAT in cells were detected by the micro assay;the levels of TNF-α,IL-6 and IL-1β in cells were detected by ELISA;the mRNA levels of BMP9,BMPR2 and SMAD1 were detected by RT-qPCR;and the expression of BMP9,BMPR2,SMAD1,Bcl-2,Bax proteins in cells was detected by Western blot.Re-sults Compared with the NC group,the proliferation activity of HPMVECs,SOD,CAT levels,Bcl-2 protein,BMP9,BMPR2,SMAD1 mRNA and protein expression levels in the LPS group were decreased(P＜0.05),the apoptosis rate and the Bax protein expression level,ROS,MDA,TNF-α,IL-6 and IL-1β levels were in-creased(P＜0.05).Compared with the LPS group,the proliferation activity of HPMVECs,SOD,CAT levels,Bcl-2 protein level,BMP9,BMPR2,SMAD1 mRNA and protein expression levels in the low,middle and high concentrations nicorandil groups were increased,the apoptosis rate and the Bax protein level,ROS,MDA,TNF-α,IL-6 and IL-1β levels were decreased obviously(P＜0.05);compared with the high concentration nic-orandil group,the si-BMP9+high nicorandil group and LPS group showed the same trend,si-BMP9 was able to reverse the protective effect of high nicorandil group on LPS induced HPMVECs injury to some extent.Conclusion Nicorandil could reduce the oxidative stress,inflammatory reaction and cell apoptosis induced by LPS in HPMVECs and inhibit LPS induced HPMVECs injury by up-regulating the expression of BMP9/BM-PR2/SMAD pathway.

Objectives:To observe the clinical efficacy of one-stage posterior debridement and iliac bone in-terbody fusion combined with vacuum sealing drainage(VSD)for wound closure and closed continuous douche(CCD)for the treatment of primary lumbar spine infection.Methods:A retrospective analysis was conducted on the case data of 18 patients with primary lumbar spine infection who underwent one-stage posterior de-bridement with iliac bone interbody grafting and VSD incision closure+CCD treatment at our hospital be-tween January 2016 and December 2021.There were 9 males and 9 females,aged 53.2±16.0 years(22-80 years).mNGS sequencing and pathogen culture were employed to identify infectious pathogens and formulate targeted antibiotic treatment plans.The levels of erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were measured from preoperative 3d to postoperative 60d(every 3 days)to evaluate the infection con-trol status.Clinical function recovery was assessed using the Barthel index(BI)and JOA scores before surgery and at 3 months postoperatively,calculating the improvement rates(significant improvement defined as ≥60％).The Frankel classification was recorded before operation and at 3 months post-operation to evaluate spinal cord injury recovery.Postoperative follow-up CT scans were conducted to record the time to bone fusion.Results:The combined results of mNGS sequencing and pathogenic culture were positive in 17 cases(17/18),including 8 cases of Staphylococcus aureus,3 cases of Escherichia coli,2 cases of Pseudomonas aeruginosa,1 case each of methicillin-resistant Staphylococcus aureus,Staphylococcus epidermidis,Enterococcus faecium,and Brucella species was also noted,all of which received appropriate sequential therapy.All the cases were followed up postoperatively for 18.0±8.2 months(12-38 months).The average levels of CRP and ESR returned to the normal ranges on postoperative 42d and 45d respectively and sustained thereafter.The BI was 63.7±11.3 points before operation,which was 89.8±7.0 points at 3 months postoperatively,with 16 cases achieving significant improvement(88.9％);The JOA score was 14.2±3.4 points before operation,which was 25.7±3.1 points at 3 months postoperatively,with 16 cases achieving significant improvement(88.9％).At 3 months af-ter operation,2 patients with Frankel grade C improved to grade E,2 improved to grade D,and the remain-ing 14 patients with Frankel grade D all improved to grade E.The average time for bone graft fusion post-surgery was 6.0±1.5 months.Conclusions:One-stage posterior debridement,iliac bone interbody grafting,and VSD incision closure combined with CCD can achieve thorough debridement,effective infection control,and reliable bone graft fusion in treating primary lumbar spine infection,which can improve neurological function of the patients.

Objectives:To observe the clinical efficacy of one-stage posterior debridement and iliac bone in-terbody fusion combined with vacuum sealing drainage(VSD)for wound closure and closed continuous douche(CCD)for the treatment of primary lumbar spine infection.Methods:A retrospective analysis was conducted on the case data of 18 patients with primary lumbar spine infection who underwent one-stage posterior de-bridement with iliac bone interbody grafting and VSD incision closure+CCD treatment at our hospital be-tween January 2016 and December 2021.There were 9 males and 9 females,aged 53.2±16.0 years(22-80 years).mNGS sequencing and pathogen culture were employed to identify infectious pathogens and formulate targeted antibiotic treatment plans.The levels of erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were measured from preoperative 3d to postoperative 60d(every 3 days)to evaluate the infection con-trol status.Clinical function recovery was assessed using the Barthel index(BI)and JOA scores before surgery and at 3 months postoperatively,calculating the improvement rates(significant improvement defined as ≥60％).The Frankel classification was recorded before operation and at 3 months post-operation to evaluate spinal cord injury recovery.Postoperative follow-up CT scans were conducted to record the time to bone fusion.Results:The combined results of mNGS sequencing and pathogenic culture were positive in 17 cases(17/18),including 8 cases of Staphylococcus aureus,3 cases of Escherichia coli,2 cases of Pseudomonas aeruginosa,1 case each of methicillin-resistant Staphylococcus aureus,Staphylococcus epidermidis,Enterococcus faecium,and Brucella species was also noted,all of which received appropriate sequential therapy.All the cases were followed up postoperatively for 18.0±8.2 months(12-38 months).The average levels of CRP and ESR returned to the normal ranges on postoperative 42d and 45d respectively and sustained thereafter.The BI was 63.7±11.3 points before operation,which was 89.8±7.0 points at 3 months postoperatively,with 16 cases achieving significant improvement(88.9％);The JOA score was 14.2±3.4 points before operation,which was 25.7±3.1 points at 3 months postoperatively,with 16 cases achieving significant improvement(88.9％).At 3 months af-ter operation,2 patients with Frankel grade C improved to grade E,2 improved to grade D,and the remain-ing 14 patients with Frankel grade D all improved to grade E.The average time for bone graft fusion post-surgery was 6.0±1.5 months.Conclusions:One-stage posterior debridement,iliac bone interbody grafting,and VSD incision closure combined with CCD can achieve thorough debridement,effective infection control,and reliable bone graft fusion in treating primary lumbar spine infection,which can improve neurological function of the patients.

Objective:To evaluate the posterior fixation with inclined-long pedicle screws for the injured vertebra combined with two-level interbody fusion for thoracolumbar burst fractures with severe disc injury.Methods:A retrospective study was conducted to analyze the clinical data of 22 patients who had been treated for thoracolumbar burst fractures with severe disc injury at Department of Orthopaedic, General Hospital of Central Theater Command from June 2016 to June 2021. There were 15 males and 7 females, aged 43.50 (29.75, 52.25) years. By the AO classification, there were 12 cases of type B2, 10 cases of type C3. All the patients were treated by the posterior fixation with inclined-long pedicle screws for the injured vertebra combined with two-level interbody fusion. The visual analogue scale (VAS), Oswestry disability index (ODI), anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), vertebral wedge angle (VWA) and spinal canal encroachment rate (SCER) were compared between pre-surgery, 1 week post-surgery, 3 months post-surgery and the last follow-up. Their neurological function was graded according to the American Spinal Injury Association (ASIA) impairment scale and interbody fusion evaluated according to their 3D CT at the last follow-up.Results:All the 22 patients were followed up for (26.1±1.3) months. In all patients, the VAS and ODI were significantly lower at 1 week post-surgery than the pre-surgery ones ( P<0.05), and then decreased significantly at 3 months post-surgery and at the last follow-up compared with the values at 1 week post-surgery ( P<0.05). For all patients, there were significant improvements in AVHR, KCA, VWA and SCER at 1 week post-surgery, 3 months post-surgery and the last follow-up compared with the pre-surgery values ( P<0.05), and the SCER at the last follow-up was significantly decreased compared with that at 1 week post-surgery ( P<0.05). All patients experienced improved neurological function in different degrees at the last follow-up, and all intervertebral spaces achieved solid bony fusion. Conclusion:In the treatment of thoracolumbar burst fractures with severe disc injury, the posterior fixation with inclined-long pedicle screws for the injured vertebra combined with two-level interbody fusion can lead to satisfactory long-term therapeutic efficacy, because this strategy can effectively reduce spinal canal encroachment, restore the height of the injured vertebra, reconstruct the curvature of the fracture area and ensure reliable intervertebral fusion.

Objective To analyze the effects of different supplements on anemia related indexes in rural children. Methods A stratified method was adopted, and six villages (towns) in and around Qinghai Province were selected as intervention sits for the present study. A total of 304 children from 2 to 6 years old at each intervention site meeting the inclusion criteria were screened and divided into three groups (A, B, and C), who were intervened for 3 months. Serum vitamin A, vitamin D and hemoglobin levels were measured before and after the intervention. Results The hemoglobin level of 304 children before intervention was (118.65±16.07) g /L, and the prevalence of anemia was 9.54%. The vitamin A value, vitamin D value and hemoglobin value were increased after three months of the intervention. The changes of vitamin A value, vitamin D value and hemoglobin value in rural children in group C were significantly higher than those in groups A and B. The increase in vitamin A value in rural children aged 3 years was significantly higher than that in other age groups, and the increase in hemoglobin in rural children of 1 year old was significantly higher than that in other age groups. The increase in vitamin A value of rural children of other ethnic groups (mainly Tibetans) was significantly higher than that of Han and Hui nationalities, and the increase of hemoglobin value in Hui rural children was significantly higher than that in Han and other ethnic groups. Conclusion Vitamin A combined with iron dextran tablets was effective in preventing anemia in rural children.

Objective:To investigate the frequency and severity of systemic reactions (SRs) to standardized house dust mite subcutaneous immunotherapy (SCIT) in patients with perennial allergic rhinitis (AR), and to analyze the clinical risk factors.Methods:The clinical data of 362 patients including 209 males and 153 females, aged from 5 to 55 years old receiving SCIT at the Department of Otorhinolaryngology, the Third People′s Hospital of Changzhou were collected from May 2014 to July 2017. The SRs were classified as early-onset and delayed-onset, and 4 grades (grade Ⅰ to Ⅳ) to assess severity. The records of SRs were retrospectively analyzed, including the numbers/frequencies, symptoms and signs, onset of reaction and treatment. And the relationships between SRs and patient′s age, gender, allergen injection dose, accompanied allergic diseases were explored. All the statistical analyses were conducted using SPSS 19.0.Results:There were 57 cases (15.75%) of SRs in 362 patients. All the patients received a total of 12 308 injections and 111 SRs (0.90%) were observed. Among them, 31 (27.93%) were early-onset reactions and 80 (72.07%) were delayed-onset reactions; most of the SRs were grade Ⅰ reactions ( n=83, 74.78%), followed by grade Ⅱ ( n=25, 22.52%), grade Ⅲ ( n=3, 2.70%), and no fatal reactions occurred. The incidence of SRs in patients>14 years old was higher than that in patients ≤14 years old according to the number of cases and injections (35.14% vs 13.54%, 2.34% vs 0.76%, χ 2 value was 11.679, 28.162, respectively, all P<0.05), but no significant differences of SRs were observed in gender (18.66% vs 11.76%, 5.98% vs 5.62%, χ 2 value was 3.166, 0.095, respectively, all P>0.05). Fifteen SRs (13.51%) occurred during the build-up phase and 96 (86.49%) during the maintenance phases. SRs could occur in lots of dose phases, and 95 (85.59%) were distributed at high concentrations more than 40 000 SQ-U. The incidence of SRs in patients with multiple allergic diseases was significantly higher than that in patients with AR alone, with asthma or atopic dermatitis (30.67% vs 11.85%, χ 2=15.875, P<0.001). Meanwhile, the incidence of SRs in patients with pure AR was also significantly lower than that in patients with other allergic diseases (5.26% vs 20.56%, χ 2=13.783, P<0.001). Conclusions:The incidence of SRs is less than 1% according to the injection times, the severity of SRs is mostly slight, and the safety and tolerance are good during standardized house dust mite SCIT in perennial AR patients. Delayed-onset SRs are more common. The incidence of SRs is significantly correlated with age, high dose of allergen vaccine injection, and concomitant other allergic diseases (asthma, atopic dermatitis, etc).

Objective To use CT and 3D reconstruction technique to locating mark of sustentaculum tali ,and measure the an‐gle & length of the specified point of the lateral wall of the calcaneus to sustentaculum tali for providing .To basis for the operation of calcaneus .Methods Thirty adult ankle wet specimens were chosen and scanned with CT ,and the dicom data were converted into the software to 3D‐reconstruction ,the observation and measurement to find new methods of locating mark of sustentaculum tali ;Forty adult calcaneus dried specimens were chosen and scanned with CT .The dicom data were converted into the software to 3D‐re‐construction ,using a workstation software measure the angle and length of the line which from the center of the sustentaculum tail to each point on the calcaneal lateral wall .Results First ,in the function of ankle joint position ,with the foot medial surface as “sag‐ittal reference plane” measurement ,the vertical line passing through the leading edge of medial malleols and the coronal line passing through the leading edge of sustentaculum tali intersect at a point .The vertical distance of the point to leading edge of medial malle‐ols was (34 .95 ± 2 .60) mm ,the length of sustentaculum tali was (21 .44 ± 1 .89) mm ,the height of sustentaculum tali was (10 .17 ± 1 .16) mm ,the anteversion of sustentaculum tali was (35 .31 ± 3 .73)° .Second ,in front of calcaneus ,upward angel of points G ,E were (28 .78 ± 3 .90 )° ,(29 .47 ± 2 .96 )° respectively .Frontward angle of points G ,E were ( - 19 .83 ± 4 .60 )° , ( - 11 .02 ± 4 .74)° respectively .Under the posterior articular surface ,upward angel of points C ,K ,I ,J were(2 .52 ± 2 .46)° ,(2 .92 ± 2 .28)° ,(14 .98 ± 2 .49)° ,(14 .38 ± 1 .90)° respectively .Frontward angle of points C ,K ,I ,J were(7 .32 ± 1 .66)° ,(19 .25 ± 1 .98)° , (10 .30 ± 2 .63)° ,(19 .33 ± 1 .97)° respectively .The length of screw was about 40 - 44 mm .The length of C point to the sustentacu‐lum tail was minimum ,and the length of G was maximum .Conclusion In the function of ankle joint position ,the sustentaculum tail can be located with the leading edge of medial malleols as a surface landmarks .The measurement of the angle and length of which from each point on the calcaneal lateral wall to sustentaculum tail by using CT .

Objective To discover the best physical training way including frequency and intensity each day ,and to guide pa‐tients to get the best cure .Methods Totally 60 chicken ,which were randomly divided into 3 groups ,20 for each ,the deep flexor tendon of the third left toes were found ,repairing after cut them off .Flexor tendon proximal were found by making knees incision then indwelling long silk line .External fixation bandage were used .Their left toes were accepted physical training ,Training stand‐ards :6 pulling backs each time ,toe flexion 1/4 arc ,but less than 2 N .For group A ,exercised once a day ,twice a day for group B , three times a day for group C .Right ones were consider as control group weren′t processed after operation .28 days later ,tendon distance was recorded by using 2 N pulling forces at tendon proximal with aspiring balance .Gross specimen was observed and histo‐logical specimens using Tang Jinen classification method to classify adhesions ,and the dates were analyzed by statistics SPSS 19 .0 . Results Group A remaining of 18 ,rate of 5 .56% ,grade Ⅰ of 1 ,Ⅱ of 2 ,Ⅲ of 4 ;Ⅳ of 10 .Group B remaining of 17 ,rate of 5 .88% , grade Ⅰ of 12 ,Ⅱ of 2 ,Ⅲ of 1 ,Ⅳ of 1 .group C remaining of 16 ,15 toes broke again ,fracture rate was 93 .75 % ,grade Ⅰ of 1 ,con‐trol group were grade Ⅳ .Between group A and B there were no significant differences in degree of adhesion(P> 0 .05) .Group A and Cs′ differences were statistically tested (P< 0 .05) .So were group B and C (P< 0 .05) .The average sliding distance for group A was (3 .01 ± 1 .58) mm ,(6 .72 ± 2 .02) mm for group B ,group C only got one sample ,8 .60mm ,and it was out of statistics .Be‐tween group A and B ,difference resulting from its tendon sliding after statistical tests(P< 0 .05) .For fracture rate ,Group A and B no significant difference was found(α′ = 0 .012 5 ,PAB > α′) .Conclusion Physical training can reduce chicken′s tendon adhesion effectively .