Objective:This study was aimed to investigate the clinical efficacy of unilateral biportal endoscopic spine surgery (UBE)-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system in the treatment of thoracolumbar burst fractures with neurological deficits.Methods:This was a retrospective observational study conducted on 21 patients with thoracolumbar burst fractures and neurological deficits treated with UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system from April 2022 to August 2023. There were 13 males and 8 females, with an average age of 48.48±14.04 years (ranging from 25 to 72 years). Injured segments were T 12 in 2 cases, L 1 in 7 cases, L 2 in 6 cases, L 3 in 3 cases, L 4 in 2 cases, and L 5 in 1 case. According to the AOSpine Thoracolumbar Spine Injury Classification System, there were 14 cases of A3N2, 2 cases of A3N3, 4 cases of A4N2, and 1 case of A4N3. Surgery time, postoperative hospital stays, and complications were recorded. Local Cobb angle, vertebral fragment intrusion area, spinal canal occupation rate, and anterior vertebral height compression rate were measured preoperatively, postoperatively, and at the last follow-up. Screw placement accuracy was assessed using postoperative CT. Neurological function was evaluated using the American Spinal Injury Association (ASIA) grading system, and clinical efficacy was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). Results:All patients successfully underwent the operation without any conversions to open surgery during the procedure. A total of 105 percutaneous pedicle screws were placed, with an accuracy rate of 96.2%. Internal fixation devices were removed in 18 cases at the last follow-up. The 21 patients were followed up for 18.38±3.66 months (ranging from 12 to 25 months). The surgery time was 150.29±18.84 min (ranging from 111 to 185 min). Postoperative hospital stay was 5.19±1.15 d (ranging from 3 to 7 d). One patient underwent interbody fusion with an autologous iliac crest bone graft and achieved bony fusion at 12 months postoperatively. Preoperative local Cobb angle, anterior vertebral height compression rate, vertebral fragment intrusion area, and spinal canal occupation rate were 22.90°±4.48°, 54.49%±7.53%, 142.90±21.00 mm 2, and 69.91%±7.07%, respectively. Postoperative values improved to 2.57°±1.09°, 5.19%±1.04%, 56.33±11.35 mm 2, and 25.72%±4.24%, with last follow-up values of 3.19°±1.01°, 5.75%±0.92%, 34.90±5.14 mm 2, and 18.25%±2.44% with significant differences ( P<0.05). Preoperatively, all patients were ASIA grade D. Within 48 hours postoperatively, 10 patients improved to grade E, and at the last follow-up, all patients achieved grade E. VAS scores significantly decreased from 8.10±0.92 preoperatively to 3.48±0.59 postoperatively and 1.52±0.73 at the last follow-up ( F=486.032, P<0.001); ODI significantly improved from 58.14%±5.08% preoperatively to 27.20%±2.65% postoperatively and 8.89%±1.19% at the last follow-up ( F=2'001.348, P<0.001). One patient developed a postoperative wound infection, which healed with regular dressing changes. Conclusions:UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system was a safe and effective approach for the treatment of thoracolumbar burst fractures with neurological deficits. This method achieved vertebral reduction, improved neurological function, stabilized spinal alignment, and maximally preserved the integrity of posterior spinal bony and ligamentous structures.

Objective:This study was aimed to investigate the clinical efficacy of unilateral biportal endoscopic spine surgery (UBE)-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system in the treatment of thoracolumbar burst fractures with neurological deficits.Methods:This was a retrospective observational study conducted on 21 patients with thoracolumbar burst fractures and neurological deficits treated with UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system from April 2022 to August 2023. There were 13 males and 8 females, with an average age of 48.48±14.04 years (ranging from 25 to 72 years). Injured segments were T 12 in 2 cases, L 1 in 7 cases, L 2 in 6 cases, L 3 in 3 cases, L 4 in 2 cases, and L 5 in 1 case. According to the AOSpine Thoracolumbar Spine Injury Classification System, there were 14 cases of A3N2, 2 cases of A3N3, 4 cases of A4N2, and 1 case of A4N3. Surgery time, postoperative hospital stays, and complications were recorded. Local Cobb angle, vertebral fragment intrusion area, spinal canal occupation rate, and anterior vertebral height compression rate were measured preoperatively, postoperatively, and at the last follow-up. Screw placement accuracy was assessed using postoperative CT. Neurological function was evaluated using the American Spinal Injury Association (ASIA) grading system, and clinical efficacy was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). Results:All patients successfully underwent the operation without any conversions to open surgery during the procedure. A total of 105 percutaneous pedicle screws were placed, with an accuracy rate of 96.2%. Internal fixation devices were removed in 18 cases at the last follow-up. The 21 patients were followed up for 18.38±3.66 months (ranging from 12 to 25 months). The surgery time was 150.29±18.84 min (ranging from 111 to 185 min). Postoperative hospital stay was 5.19±1.15 d (ranging from 3 to 7 d). One patient underwent interbody fusion with an autologous iliac crest bone graft and achieved bony fusion at 12 months postoperatively. Preoperative local Cobb angle, anterior vertebral height compression rate, vertebral fragment intrusion area, and spinal canal occupation rate were 22.90°±4.48°, 54.49%±7.53%, 142.90±21.00 mm 2, and 69.91%±7.07%, respectively. Postoperative values improved to 2.57°±1.09°, 5.19%±1.04%, 56.33±11.35 mm 2, and 25.72%±4.24%, with last follow-up values of 3.19°±1.01°, 5.75%±0.92%, 34.90±5.14 mm 2, and 18.25%±2.44% with significant differences ( P<0.05). Preoperatively, all patients were ASIA grade D. Within 48 hours postoperatively, 10 patients improved to grade E, and at the last follow-up, all patients achieved grade E. VAS scores significantly decreased from 8.10±0.92 preoperatively to 3.48±0.59 postoperatively and 1.52±0.73 at the last follow-up ( F=486.032, P<0.001); ODI significantly improved from 58.14%±5.08% preoperatively to 27.20%±2.65% postoperatively and 8.89%±1.19% at the last follow-up ( F=2'001.348, P<0.001). One patient developed a postoperative wound infection, which healed with regular dressing changes. Conclusions:UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system was a safe and effective approach for the treatment of thoracolumbar burst fractures with neurological deficits. This method achieved vertebral reduction, improved neurological function, stabilized spinal alignment, and maximally preserved the integrity of posterior spinal bony and ligamentous structures.

The unilateral biportal endoscopic technique is defined as posterior unilateral of two small incision with established percutaneous observation channel and endoscopic observation channel in monitoring field. The operation tools were placed within the channel for each operation inside and outside vertebral canal. The characteristics of dual channel intervention make this technology different from coaxial endoscopic technology. This technique has a clear vision for flexible and convenient operation with the advantages of relatively simple surgical instrument requirements. In recent years, the use of unilateral dual channel endoscopic surgery in treating spinal diseases was gradually increasing, especially in the removal of nucleus including lumbar intervertebral disc protrusion and lumbar spinal stenosis disease decompression, and in endoscopic space-occupying lesions such as vertebral fusion and spinal canal between inside and outside. It was also applied in cervical and thoracic diseases with good clinical effects. Its advantages include less surgical trauma and faster recovery process. In addition, it has a large surgical field of vision under the microscope for easy identification of structures and surgery and with relatively gentle learning curve. Thus, it is conducive to beginners' mastery. However, complications such as nerve injury and postoperative lower limb numbness are still frequently reported. Some factors have to be considered, including insufficient understanding of the new technology, the local anatomy of the dual-channel endoscope, the operation of the spinal canal under the microscope. The successful application of the technique in treating various lumbar diseases needs understanding the operation process of the technique and local anatomy under the microscope.

Objective:To develop a unilateral biportal endoscopic technique and investigate the clinical efficacy of unilateral biportal endoscopic technique in the treatment of lumbar disc herniation and lumbar spinal stenosis.Methods:Between July 2018 and June 2019, 60 patients with lumbar disc herniation or spinal stenosis were treated by unilateral biportal endoscopic technique. According to the inclusion and exclusion criteria, 51 patients were included in the study. There were 25 cases of prolapsed lumbar disc herniation, 26 cases of degenerative lumbar spinal stenosis, all of which were treated with posterior lumbar decompression by unilateral biportal endoscopic laminectomy, and contralateral stealth decompression by unilateral approach was performed on the patients with bilateral stenosis. Endoscopic interbody fusion and percutaneous pedicle screw fixation were performed in 5 patients with instability. Operation time, length of incision, hospital stay and complications were recorded. Visual analogue scale (VAS) for low back pain and leg pain, Oswestry dysfunction index (ODI) and the modified Macnab scale were used to evaluate the clinical efficacy.Results:All operations were completed successfully, and no cases were transferred to open surgery. The operative time was 70.29±19.55 min (44-151 min), while the length of incision was 1.79±0.34 cm (1.4-3.0 cm). Postoperative CT suggested complete decompression with intact contralateral structure. All patients got out of bed 1-3 d after surgery, and the postoperative hospital stay was 3.49±2.76 d (1-14 d). The postoperative follow-up time was 13.59±2.80 months (10-21 months). Forty-six patients returned to work or normal activities within 3 weeks and 5 patients with interbody fusion returned to normal activities within 4 weeks. According to the modified Macnab criteria, the final outcome was excellent in 43 cases, good in 6 cases, and fair in 2 cases. There were 3 cases of dural sac tear during operation and 2 cases of transient numbness of lower limbs after surgery and they all recovered after conservative treatment. The VAS score of low back pain of 26 patients with lumbar spinal stenosis was reduced from 6.69±1.44 before surgery to 3.27±1.43 at postoperative 1 month, 2.69±1.57 at postoperative 3 months, 2.31±1.16 at postoperative 6 months and 2.23±1.28 at the last follow-up, respectively, and the difference was statistically significant ( F=128.534, P<0.005). The VAS scoreof leg pain was reduced from 6.77±1.34 before surgery to 3.27±1.37 at postoperative 1 month, 2.88±1.48 at postoperative 3 months, 2.85±1.52 at postoperative 6 months and 2.54±1.53 at the last follow-up, and the difference was statistically significant ( F=146.951, P<0.005). The ODI score was reduced from 64.18%±8.23% before surgery to 37.53%±4.45% at postoperative 1 month, 27.51%±3.83% at postoperative 3 months, 19.91%±5.27% at postoperative 6 months and 6.84%±2.74% at the last follow-up, and the difference was statistically significant ( F=783.966, P<0.005). The VAS score of low back pain of 25 patients with lumbar disc herniation was reduced from 5.60±1.38 before surgery to 3.04±1.54 at postoperative 1 month, 2.84±1.75 at postoperative 3 months, 3.12±1.86 at postoperative 6 months and 3.44±1.69 at the last follow-up, respectively, and the difference was statistically significant ( F=22.357, P<0.005). The VAS scoreof leg pain was reduced from 5.48±1.45 before surgery to 2.88±1.64 at postoperative 1 month, 2.52±1.83 at postoperative 3 months, 2.76±1.83 at postoperative 6 months and 3.00±1.92 at the last follow-up, and the difference was statistically significant ( F=29.445, P<0.005). The ODI score was reduced from 53.59%±6.87% before surgery to 32.46%±3.78% at postoperative 1 month, 23.39%±2.78% at postoperative 3 months, 16.49%±3.49% at postoperative 6 months and 7.23%±3.15% at the last follow-up, and the difference was statistically significant ( F=790.985, P<0.005). Conclusion:Unilateral biportal endoscopic technique has the advantages of clear and wide field of vision, large operating space, relatively simple surgical instrument need and convenient and flexible operation procedure. It has excellent clinical effects in the treatment of lumbar disc herniation and lumbar spinal stenosis.

Objective To investigate the clinical effect of urethral plate combined with unilateral crescent flap in the treatment of hypospadias in children.Methods The clinical data of 14 cases of hypospadias treated from March 2017 to March 2018 were retrospectively analyzed,with average age of (3.3 ± 2.1) years.The external urethral orifice was located in the middle and distal part of the ventral side of the penis,with mild and moderate bends of the penis.The prepuce was piling up on the penile dorsal side,the ventral skin was deficient,and there was no concomitant disease such as penis scrotum transposition or cryptorchidism.All children were primarily treated with urethroplasty with urethral plate and one crescent flap.One side of the free urethral plate had a crescent superficial fascia,which was used as the new urethral material together with the urethral plate.By design,the urethra sutured deviating from the midline.The external urethral orifice was formed by trimming the anterior opening of urethra in the form of shallow "V" shape,and the new urethra was covered with the dorsal fleshy vascular pedicle.The pterygoid flap of the penis was sutured to form the penile head,and the foreskin was cut to cover the body of the penis.The specimens were taken for HE staining.Results The operation was successfully completed in 14 children.The length of the penis was measured before it is stretched out.The penile length was(3.5 ±0.5)cm,the penile diameter was(1.2 ±0.3) cm at the coronal sulcus,and the diameter of the tortoise head was (1.5 ± 0.3) cm at the pterygoid.The width of urethral plate was (0.6 ± 0.1) cm.Remeasurement was performed after complete correction of penile bending deformity.The length of the penis was (3.5 ± 0.5) cm,and the urethral defect was (1.7 ± 0.7)cm.According to Barcat method,there were 2 cases of coronal sulcus type,7 cases of anterior penile type and 5 cases of middle penile type.The results of HE staining showed that the number of blood vessels in the dorsal prepuce and fascia was (8.5 ± 2.1),dorsal foreskin plate was (5.1 ± 1.6),ventral prepuce internal plates was (7.6 ± 1.8),and ventral outer prepuce plates was (4.8 ±1.6).The number of superficial fascia vessels and deep fascia vessels were (10.3 ± 1.4) and (4.2 ± 1.7).The analysis of variance showed that there was significant difference in the mean number among groups(P =0.036),which was compared with each other by SNK-q test.The number of fasciae in dorsal prepuce was the most abundant,there was significant difference between dorsal and outer prepuce(P =0.033),and there was also significant difference with ventral prepuce(P =0.047).But there was no significant difference between the two groups(P =0.326).There was no significant difference in the number of blood vessels between the dorsal and ventral prepuce (P =0.682).The number of superficial fascia vessels near the skin was significantly more than that of deep fascia(P =0.037).On the transverse plane,there are more branches of the superficial fascia to the urethral plate at the junction of the ventral external plate and the urethral plate.All 14 cases were followed up for 3 to 9 months with an average of(5.4 ± 2.1) months.The penis was straight and satisfactory,urethral orifice was not cracked,urination was laborious and not forked,and there was no fistula.One patient with middle penile type developed postoperative infection and was controlled after antiinfective treatment.One patient with anterior penile type had slight urination after operation,but had no difficulty in urination.F6 metal urethral dilator was used to dilate for 2 months,and the urination was normal.Conclusion Urethral plate combined with crescent flap urethroplasty for hypospadias has a satisfactory appearance and fewer complications.It provides an optional operative method for the children who need no transection of urethra plate to straighten the penis,especially for the poor development of the penis and the insufficiency of the new urethral materials.The superficial fascia tissue on both sides of the urethral plate is an ideal material for the new urethra because of its abundant blood supply adjacent to the urethral plate and direct vascular connection.

OBJECTIVETo investigate the effects of rs10916581, a common single nucleotide polymorphism (SNP) located in the promoter region of pre-miR-320b-2, on coronary heart disease (CHD) risk and circulating microRNA-320b (miR-320b) level. To explore potential factors influencing circulating miR-320b level.

METHODSRs10916581 was genotyped in a case-control study with 1 507 CHD cases and 1 379 age- and sex-frequency-matched controls. The cases were consecutively recruited from 3 hospitals (Tongji Hospital, Union Hospital, and Wugang Hospital) in Wuhan city (Hubei, China) between May 2004 and October 2009 and all the controls resided in Wuhan communities. A subgroup of 174 CHD cases and 181 non-diabetes controls without acute infection were randomly selected and their circulating miR-320b levels were detected using quantitative reverse transcriptase polymerase chain reaction assays. The association of rs10916581 with CHD susceptibility was analyzed with multivariable logistic regression model. Generalized linear regression model was used to explore the associations of rs10916581 and some other factors with circulating miR-320b level.

RESULTSIn single-factor logistic regression analysis, no association was found between rs10916581 and CHD risk. After adjustment for age, sex, BMI, smoking status, hypertension, diabetes, total triglyceride, total cholesterol/high density lipoprotein (TC/HDL-C), the result did not materially alter(compared with CC genotype, the OR (95%CI) of CHR in the subjects carried CT, TT, CT+TT genotypes were 0.94 (0.76-1.15), 0.99 (0.74-1.33) and 0.95 (0.78-1.16) ). No significant interactions were observed between the conventional risk factors of CHD (age, gender, smoking status, BMI, hypertension, diabetes, CHD family history) and rs10916581 on CHD risk (P > 0.05). Rs10916581 showed no significant association with circulating miR-320b level in cases, controls or total population (β(95%CI) was -0.028 (-0.495-0.440), 0.250 (-0.226-0.727) and 0.134 (-0.218-0.486) respectively, P > 0.05). However, circulating miR-320b level was negatively associated with BMI (β (95%CI) was -0.140 (-0.261--0.020), P = 0.022) while positively associated with TC/HDL(β (95%CI) was 0.620 (0.261-0.979), P = 0.001) in cases, and in total population, its circulating level tended to be lower in diabetes or hypertension patients (β(95%CI) was -1.025 (-1.696--0.354) and -0.594 (-1.138--0.049) respectively, P = 0.003, 0.033 respectively) and was positively associated with TC/HDL-C (β(95%CI) was 0.108 (0.027-0.190), P = 0.009).

CONCLUSIONThe common SNP (rs10916581) in the promoter region of pre-miR-320b-2 might have little contribution to the CHD predisposition in Chinese Han population, and it might not affect circulating miR-320b level. Conventional CHD risk factors (BMI, TC/HDL-C, hypertension and diabetes) might have effects on its circulating level.

Aged ; Case-Control Studies ; China ; ethnology ; Coronary Disease ; genetics ; Diabetes Mellitus ; Genotype ; Humans ; Hypertension ; Logistic Models ; MicroRNAs ; adverse effects ; blood ; genetics ; Polymorphism, Single Nucleotide ; genetics ; Promoter Regions, Genetic ; Risk Factors ; Triglycerides

BACKGROUND: Ions doping is an important method for the modification of bioceramic.OBJECTIVE: To evaluate a novel co-substituted bioceramic scaffolds as bone repair material.METHODS: The microstructure and crystallization of the scaffolds were detected by scanning electron microscope and X-ray diffraction. Compression strength test,degradation test and cell culture experiment were assumed to evaluate the properties of KSCPP in vitro. After a short period of muscle pouches implantation,the performance of KSCPP in vivo was evaluated.RESULTS AND CONCLUSION: The results show that KSCPP scaffold has a higher compressive strength and degradation rate. Moreover,the MTT assay and implantation test reveal that the KSCPP scaffold exhibits lower cytotoxicity and better tissue biocompatibility than CPP and HA. The study proved the great potential of KSCPP in bone repair applications.