1.Diagnosis of an Outbreak of Canine Distemper in Cynomolgus Monkeys in an Experimental Monkey Farm in 2019
Chenjuan WANG ; Lingyan YANG ; Lipeng WANG ; Xueping SUN ; Jingwen LI ; Lianxiang GUO ; Rong RONG ; Changjun SHI
Laboratory Animal and Comparative Medicine 2025;45(3):360-367
Objective To report the diagnosis of a canine distemper virus outbreak among a colony of cynomolgus monkeys at an experimental monkey farm in 2019. MethodsA total of 46 samples were collected from 21 diseased cynomolgus monkeys (exhibiting symptoms such as facial rash, skin scurf, runny nose, and diarrhea) and from one deceased monkey at an experimental monkey breeding farm in South China in late 2019, including serum, skin rash swabs, and anticoagulated whole blood, liver, lung, and skin tissues were submitted for testing. All submitted samples were tested for canine distemper virus gene fragments using real-time quantitative PCR, while immunohistochemical staining was performed to detect canine distemper virus nucleoprotein in lung tissues. The skin tissue of the deceased monkey was ground and sieved. The filtrate was inoculated into a monolayer MDCK cell line for virus isolation. Then, whole-genome sequencing was performed to identify the isolated virus. The Clustal Omega tool was used to align and analyze the homology of different Asian canine distemper virus isolates. A phylogenetic tree was constructed, followed by genetic evolutionary analysis. ResultsClinical retrospective analysis revealed that the diseased cynomolgus monkeys exhibited symptoms similar to those observed in cynomolgus monkeys infected with measles virus. Necropsy findings showed red lesions in the lungs and significant hemorrhage in the colonic mucosa. Real-time quantitative PCR detected canine distemper virus nucleic acid in the serum, skin rash swabs of the infected monkeys, and various tissue samples of the deceased monkey, all of which tested positive. Calculation based on the standard curve formula indicated the viral load was highest in the skin tissue. Immunohistochemical staining of the deceased monkey's lung tissue demonstrated aggregation of CDV nucleoprotein in alveolar epithelial cells, bronchi, and bronchioles. A CDV strain was isolated from the skin tissue of the deceased monkey. Phylogenetic analysis indicated that this strain shares the closest relationship (98.86%) with the Asian-1 type canine distemper virus strain CDV/dog/HCM/33/140816, previously identified in dogs in Vietnam. ConclusionBased on comprehensive analysis of clinical symptoms, nucleic acid detection, viral protein immunohistochemistry, and whole-genome sequencing results, the diagnosis confirms that the cynomolgus monkeys in this facility are infected with canine distemper virus. It is recommended to include canine distemper virus as a routine surveillance target in captive monkey populations. Additionally, this study provides a foundation for further research on the molecular biological characteristics of canine distemper virus.
2.Diagnosis of an Outbreak of Canine Distemper in Cynomolgus Monkeys in an Experimental Monkey Farm in 2019
Chenjuan WANG ; Lingyan YANG ; Lipeng WANG ; Xueping SUN ; Jingwen LI ; Lianxiang GUO ; Rong RONG ; Changjun SHI
Laboratory Animal and Comparative Medicine 2025;45(3):360-367
Objective To report the diagnosis of a canine distemper virus outbreak among a colony of cynomolgus monkeys at an experimental monkey farm in 2019. MethodsA total of 46 samples were collected from 21 diseased cynomolgus monkeys (exhibiting symptoms such as facial rash, skin scurf, runny nose, and diarrhea) and from one deceased monkey at an experimental monkey breeding farm in South China in late 2019, including serum, skin rash swabs, and anticoagulated whole blood, liver, lung, and skin tissues were submitted for testing. All submitted samples were tested for canine distemper virus gene fragments using real-time quantitative PCR, while immunohistochemical staining was performed to detect canine distemper virus nucleoprotein in lung tissues. The skin tissue of the deceased monkey was ground and sieved. The filtrate was inoculated into a monolayer MDCK cell line for virus isolation. Then, whole-genome sequencing was performed to identify the isolated virus. The Clustal Omega tool was used to align and analyze the homology of different Asian canine distemper virus isolates. A phylogenetic tree was constructed, followed by genetic evolutionary analysis. ResultsClinical retrospective analysis revealed that the diseased cynomolgus monkeys exhibited symptoms similar to those observed in cynomolgus monkeys infected with measles virus. Necropsy findings showed red lesions in the lungs and significant hemorrhage in the colonic mucosa. Real-time quantitative PCR detected canine distemper virus nucleic acid in the serum, skin rash swabs of the infected monkeys, and various tissue samples of the deceased monkey, all of which tested positive. Calculation based on the standard curve formula indicated the viral load was highest in the skin tissue. Immunohistochemical staining of the deceased monkey's lung tissue demonstrated aggregation of CDV nucleoprotein in alveolar epithelial cells, bronchi, and bronchioles. A CDV strain was isolated from the skin tissue of the deceased monkey. Phylogenetic analysis indicated that this strain shares the closest relationship (98.86%) with the Asian-1 type canine distemper virus strain CDV/dog/HCM/33/140816, previously identified in dogs in Vietnam. ConclusionBased on comprehensive analysis of clinical symptoms, nucleic acid detection, viral protein immunohistochemistry, and whole-genome sequencing results, the diagnosis confirms that the cynomolgus monkeys in this facility are infected with canine distemper virus. It is recommended to include canine distemper virus as a routine surveillance target in captive monkey populations. Additionally, this study provides a foundation for further research on the molecular biological characteristics of canine distemper virus.
3.Clinical evolution and atypical spinal cord MRI features of myelitis post severe acute respiratory syndrome coronavirus 2 infection
Jie WANG ; Lipeng ZHAO ; Lingli YANG
Journal of Clinical Neurology 2024;37(1):1-8
Objective To analyze the clinical evolution and atypical spinal cord MRI features of myelitis post severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.Methods Four patients with myelitis post the SARS-CoV-2 infection were retrospectively analyzed regarding the clinical manifestations,the dynamic changes of the spinal cord MRI and the treatment outcomes.Results The time latencies from SARS-CoV-2 infection to the onset of myelitis of the 4 patients were 5 d,15 d,80 d,and 30 d,respectively.The onset symptoms were numbness and weakness of lower limbs in 3 patients,and back pain with weakness of lower limbs in 1 patient.The peak symptoms included paraplegia,sphincter dysfunction,sensory plane and spastic gait.The expanded disability status score(EDSS)of the 4 patients were 7.5,9.0,9.0 and 7.5,respectively.Initial spinal cord MRI showed normal in 1 case,linear meningeal enhancement in 1 case,and punctate T2 signal changes in 2 cases.Spinal cord MRI at the peak of the symptoms showed patchy,linear and cloudy-like high signals on sagittal T2,which mainly distributed in lateral and posterior cords on axial T2.The prominent features of the MRI findings were the linear meningeal enhancement that appeared in all 4 cases during the disease and their mismatch with the severity of clinical symptoms.Two of the four patients received pulse methylprednisolone combined with plasma exchange therapy and did not show significant improvement,and all 4 patients were left with significant disability.Conclusions Myelitis post SARS-CoV-2 infection usually presents typical symptoms of myelitis,while the spinal cord MRI presents patchy,linear and cloudy-like high signals,with linear meningeal enhancement.The delayed and atypical spinal cord MRI findings need additional attention.
4.Clinical analysis of 29 cases of postsurgical gastroparesis syndrome after laparoscopic radical resection of right-side colon cancer
Yang LI ; Tao LIU ; Lipeng ZENG ; Yuanxiang HU
Journal of Clinical Surgery 2024;32(2):196-198
Objective To investigate the influencing factors of postoperative gastroparesis syndrome(PSG)after laparoscopic right hemicolon cancer resection.Methods A total of 1070 patients with laparoscopic right hemicolon cancer resection(complete right hemicolon mesoresection)were selected from Wuhan General Hospital of Yangtze River Shipping and Wuhan Union Hospital Cancer Department from December 2012 to June 2022.According to whether the patients got postoperative gastroparesis,were divided into the postoperative gastroparesis syndrome(PSG)group or the normal control group.Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of PGS after right hemicolon resection.Results There were 29 patients in the gastroparesis group and 1041 patients in the normal control group.Univariate analysis showed that age,perioperative blood glucose level,surgical resection range,and surgical approach were related to the occurrence of PGS(P<0.05).Multivariate Logistic analysis showed that age,high perioperative blood glucose level,caudal approach plus combined approach,and large surgical resection range were independent influencing factors of PGS(P<0.05).Conclusions Age,high perioperative blood glucose level,caudal approach plus combined approach,and large surgical resection range are influencing factors of PGS.
5.Glabridine regulates NETs to inhibit pyrodeath and alleviate lung injury in sepsis
Lingqing YANG ; Chendong MA ; Lei WANG ; Min WANG ; Zengliang LI ; Lipeng ZHANG
Chinese Journal of Emergency Medicine 2024;33(2):179-185
Objective:To investigate the effect of glabridin on neutrophil extracellular traps (NETs) formation and pyroptosis in rats with sepsis-induced lung injury.Methods:Twenty-four male Wistar rats were divided into three groups according to the random number table method. The sepsis group was established by cecal ligation and puncture (CLP). The Glabridin group underwent CLP and glabridin gavage (30 mg/kg)(CLP+GLA). The sham operation group underwent cecal exploration, and only the abdomen was closed after cecal turning(Sham). After 12 hours, plasma、alveolar lavage fluid and lung tissue samples were taken for detection . Then, protein content of the alveolar lavage fluid was determined; The wet/dry weight(W/D) ratio of the lung tissue was determined; The pathological changes in lung tissue were observed after hematoxylin-eosin (HE) staining. The levels of NETs marker MPO-DNA complex and related inflammatory factors IL-18 and IL-1β in plasma were detected by enzyme-linked immunosorbent assay. The changes of Caspase-1and Cleaved-caspase-1 protein in lung tissue were detected by Western blot.Results:The total protein concentration of alveolar lavage fluid was significantly higher in the sepsis group compared with the Sham group ( P<0.01), and it decreased in the glabridin group compared with the sepsis group ( P<0. 05). Significant aggravation of pulmonary edema in the sepsis group, and the glabridin group reduced pulmonary edema compared with the sepsis group.The pathological results of lung tissue under the light microscope showed: The structure of lung tissue in the Sham group was normal, and the alveoli were clear; In the sepsis group, the alveolar wall was thickened widely and inflammatory cells infiltrated obviously; Compared with the sepsis group, the lung tissue injury was significantly reduced in the light licorice group. The enzyme-linked immunosorbent assay results showed that the levels of NETs marker MPO-DNA complex and inflammatory factors IL-18 and IL-1β in the plasma of the sepsis group were significantly higher than those in the Sham group ( P<0.001). The levels of NETs marker MPO-DNA complex and inflammatory factors IL-18 and IL-1β in the glabridin group were significantly lower than those in the sepsis group (MPO-DNA: P<0. 01; IL-18、IL-1β: P<0.05) . Western blot Technical results showed that the expression of Caspase-1 and Cleaved-caspase-1 protein positive signal was significantly enhanced in the lung tissue of the rats in the sepsis group compared with the Sham group; the distribution of Caspase-1 positive cells in the lung tissue of the sepsis + glabridin group was similar to that of the Sham group, and the expression of Cleaved-caspase-1 positive signal was higher than that of the Sham group. Conclusions:Glabridin can effectively reduce lung inflammation and play a protective role in lung injury in septic rats by inhibiting NETs production and pyroptosis.
6.Analysis of the suspected cases of measles and rubella in Pudong New Area of Shanghai, 2013‒2022
Xiao WANG ; Aihua ZHANG ; Huiqin FU ; Yuying YANG ; Xiaoxian CUI ; Lipeng HAO ; Yanqiu ZHOU ; Lifeng PAN
Shanghai Journal of Preventive Medicine 2024;36(6):534-539
ObjectiveTo analyze the epidemic characteristics of measles and rubella in Pudong New Area of Shanghai from 2013 to 2022, and to provide data support for the elimination of measles and rubella. MethodsEnzyme linked immunosorbent assay was used to detect IgM antibodies in serum samples. The sequence of 630 nucleotides at the C-terminal of N gene of measles virus was amplified by reverse transcription-polymerase chain reaction and the phylogenic tree was constructed. ResultsA total of 1 529 suspected cases of measles were detected from 2013 to 2022, among which the positive rate of measles IgM antibody was 33.55% (513/1 529). The highest positive rate (20.73%) was from March to May , and the positive rate of rubella IgM antibody was 6.80% (104/1 529). The positive rate of both IgM was higher in males than that in females (P<0.05). The IgM against measles was mainly detected in 0‒ years old (63.16%, 96/152) and 20‒ years old (45.61%, 161/353). The IgM against rubella was mainly detected in 10‒20 years old (27.27%, 18/66). The IgM antibody could be detected more easily from 4 to 28 days after eruption, and the IgM antibody positive rate of measles/rubella from 2020 to 2022 was significantly lower than previous years (2013‒2019). There were 2 D8 genotype strains, and the rest were H1a gene subtypes. ConclusionThe positive rate of IgM antibodies against measles/rubella in Pudong New Area of Shanghai decreased significantly. People aged 0‒ years and 20‒ years old are more susceptible to measles, and rubella is concentrated in 10‒ years old. It is necessary to strengthen the vaccination of school-age children, in order to achieve the goal of eliminating measles. The age group with high risk of exposure should be checked for vaccination status to ensure the enhanced immunization, and the surveillance of imported measles cases should be strengthened.
7.Construction of data source indicator system for acute respiratory infectious disease surveillance based on the Delphi method
Yaoyao WANG ; Dazhu HUO ; Zhongjie LI ; Chuchu YE ; Lipeng HAO ; Weizhong YANG
Chinese Journal of Epidemiology 2024;45(11):1605-1610
Objective:To establish an indicator system for surveillance of data sources to provide a theoretical basis for respiratory infectious disease surveillance and early warning.Methods:Indicators for data sources in the surveillance of acute respiratory infectious diseases were initially compiled through a literature search. Subsequently, two rounds of expert consultations were conducted with 22 experts using the Delphi method to refine the indicators.Results:The questionnaire recovery rates for the two rounds of expert consultation were 100.00% and 86.36%, respectively. The authority coefficient of the experts was 0.83. The coordination coefficient of the second round of Delphi expert consultation was 0.32, and the coefficient of variation of each indicator was less than 0.25. Finally, the indicators system of data source for the surveillance of acute respiratory infectious diseases includes 4 first-level indicators, 10 second-level indicators, and 26 third-level indicators.Conclusion:The indicator system of data sources for the surveillance of acute respiratory infectious diseases constructed in this study is reasonable and reliable, providing a valuable reference for surveillance, early warning and policy formulation of acute respiratory infectious diseases.
8.Analysis of detection of acute respiratory infection in children under 12 years old in Pudong New Area, Shanghai from 2019 to 2023
Yang YUAN ; Lu ZHANG ; Zhuyun LI ; Yue ZHANG ; Yujia HUO ; Jialiang CHEN ; Qing LIU ; Wenwei ZOU ; Bing ZHAO ; Lipeng HAO ; Lifeng PAN
Shanghai Journal of Preventive Medicine 2024;36(4):342-347
ObjectiveTo investigate the impact of acute respiratory infections in children under 12 years old in Pudong New Area, Shanghai from 2019 to 2023. MethodsAcute respiratory infection samples of children under 12 years old from three sentinel hospitals in Pudong New Area, Shanghai from 2019 to 2023 were collected, and 42 respiratory infection pathogens, including influenza virus, adenovirus, parainfluenza virus, respiratory syncytial virus, human enterovirus/rhinovirus, human pulmonary virus, human bokavirus, coronavirus (229E, HKU1, NL63 and OC43), and novel coronavirus, were detected with microfluidic chips. The situation of acute respiratory infections among outpatient and inpatient children in this area was analyzed for the before the implementation of non pharmacological intervention measures (2019.12‒2020.1), during the period of non pharmacological intervention measures (2020.2‒2022.12), and after non pharmacological intervention measures (2023.1‒2023.6). ResultsFrom 2019 to 2023, a total of 1 770 samples were collected, and 445 pathogens were detected, with a detection rate of 25.14% (445/1 770). The main pathogens detected during the study period were influenza virus: 8.70% (154/1 770), respiratory syncytial virus: 4.41% (78/1 770), human enterovirus/rhinovirus: 2.66% (47/1 770), human adenovirus: 2.49% (44/1 770), and parainfluenza virus: 2.20% (39/1 770). Before the implementation of non pharmacological intervention measures, outpatients were primarily infected with influenza, parainfluenza virus, and respiratory syncytial virus, with detection rates of 8.09%, 4.49%, and 4.04%, respectively; inpatients were mainly infected with influenza, respiratory syncytial virus, and parainfluenza virus, with detection rates of 4.49%, 3.82%, and 3.15%, respectively. During the period of non pharmacological intervention measures, influenza, rhinovirus and respiratory syncytial virus were the main viruses detected in the samples of outpatient children, with detection rates of 4.04%, 3.60%, and 2.47%, respectively; inpatient samples mainly detected respiratory syncytial virus, rhinovirus, and influenza virus, with detection rates of 3.60%, 2.02%, and 1.80%, respectively. After non pharmacological intervention measures, influenza, rhinovirus and respiratory syncytial virus were the main pathogens detected in the outpatients, with detection rates of 9.89%, 2.92% and 2.02%, respectively; influenza, respiratory syncytial virus, and rhinovirus were the main pathogens detected in inpatient children, with detection rates of 6.29%, 1.57%, and 1.35%, respectively. ConclusionThe prevalence of pathogens related to acute respiratory infections in children is influenced by non pharmacological preventive measures.
9.Current status of radiological Kashin-Beck disease among school-aged children in Chamdo City, Tibet
Jiaxiang GAO ; Hu LI ; Liyi ZHANG ; Zihao HE ; Ziyi YANG ; Zhichang LI ; Kai WANG ; Yan KE ; Qiang LIU ; Shu ZHANG ; Xiaobo CHENG ; Shuai CHAI ; Zhaoyang MENG ; Lipeng SUN ; Qunwei LI ; Hongqiang GONG ; Jianhao LIN
Chinese Journal of Orthopaedics 2024;44(1):33-40
Objective:This study aimed to explore the status of radiological Kashin-Beck disease (KBD) among school-aged children in Chamdo City, Tibet, through a 3-year monitoring survey, providing epidemiological evidence for prevention and control strategies.Methods:The target areas for this study were Luolong, Bianba, and Basu counties in Chamdo City, Tibet Autonomous Region, identified as having the most severe historical cases of KBD. Children aged 7-12 years attending school were enrolled as study subjects. Anteroposterior X-ray films of the right-hand were taken, and radiological diagnoses were made based on the "Diagnosis of Kashin-Beck Disease" criteria (WS/T 207-2010). Two experienced researchers independently reviewed the X-rays, and intra- and inter-group consistency were assessed using weighted Kappa values and percentage agreement. Cross-sectional surveys were conducted in 2017 and 2020 to describe the X-ray detection rates of KBD, and logistic regression analysis was employed to construct a predictive model of risk factors for radiological KBD cases.Results:In 2017, a total of 5,711 children aged 7-12 years in Chamdo City, Tibet, participated in the baseline cross-sectional survey (average age 9.2 years, 48.0% female), with 28 cases of radiological KBD. The age- and gender-standardized prevalence rate was 0.527%. In 2020, 6,771 participants (average age 9.3 years, 49.5% female) underwent a second cross-sectional survey, with 9 cases of radiological KBD and a standardized prevalence rate of 0.134%. Logistic regression analysis indicated that older age [ OR=2.439, 95% CI(1.299, 4.580), P=0.006] and female gender [ OR=8.157, 95% CI(1.016, 65.528), P=0.048] were independent risk factors for radiological KBD cases. Conversely, higher residential altitude, under the premise of Tibet's high altitude, was a protective factor [ OR=0.995, 95% CI(0.990, 0.999), P=0.032). Conclusion:The radiographically positive detection rate of KBD among school-aged children in Chamdo City, Tibet Autonomous Region, is at an extremely low level and showing a declining trend, reaching the historical standard in 2020. Considering the absence of positive signs in affected children, it suggests that local KBD has been effectively eliminated.
10.One-stage posterior approach via multifidus-Iongissimus cleavage planes for debridement combined with autogenous bone grafting and internal fixation in the treatment of thoracolumbar suppurative spondylitis in adults
Yanjiang GUO ; Yunbo YANG ; Lipeng ZHENG
Chinese Journal of Spine and Spinal Cord 2024;34(7):728-735
Objectives:To explore the clinical effects of one-stage posterior approach via multifidus-longis-simus cleavage planes for lesion debridement,bone grafting and internal fixation in the treatment of thora-columbar suppurative spondylitis in adults.Methods:73 patients with thoracic or lumbar pyogenic spondylitis who underwent one-stage posterior approach via multifidus-longissimus cleavage planes for lesion removal and bone grafting and internal fixation in the Department of Orthopedics,the Affiliated Hospital of Southwest Medical University from February 2019 to February 2021 were retrospectively analyzed.There were 52 males and 21 females,aged 35-75 years(56.5±10.7 years);T1-T10 in 15 cases,T11-L2 in 32 cases,and L3-L5 in 26 cases.Obvious kyphotic deformity was found locally in all the patients.23 cases were accompanied with intraspinal epidural abscess,and 17 cases with paravertebral or psoas major muscle abscess.7 cases were combined with neurological impairment,and the American Spinal Injury Association(ASLA)classification of neurological function was detailed in 1 case of grade C and 6 cases of grade D.24 cases were complicat-ed with cardiovascular and cerebrovascular diseases,35 cases with diabetes,and 30 cases had a history of invasive operation.The venous blood was collected for bacterial culture before operation.All the patients were treated with one-stage posterior approach via multifidus-longissimus cleavage planes for lesion removal and bone grafting and internal fixation.The lesion tissue was taken for bacterial culture during operation.The postoperative irrigation lasted for 10-14d,and the anti-infection treatment lasted for 6-8 weeks.The operative time,intraoperative blood loss,and length of hospital stays,and complications were recorded;Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and procalcitonin(PCT)were compared preoperatively and be-fore discharge;Visual analogue scale(VAS)scores of thoracolumbar back pain before operation and discharge and at final follow-up were compared.The Cobb angles of kyphosis of the lesion segment were measured on radiographs,and the rate of correction of kyphosis and loss angle of correction at the final follow-up were calculated;The recovery of spinal cord function(ASIA grade)and bone graft fusion at final follow-up were ob-served and evaluated.Results:All the patients underwent the surgery successfully.The operative time was 195.8±15.5min,the intraoperative blood loss was 562.1±45.5mL,and the length of hospital stays were 18.0±2.0d.Postoperative complications occurred in 9 patients(12.3%):2 patients had delirium syndrome,which gradually disappeared after oral administration of olanzapine;4 cases had lower limb pain and numbness,and the symptoms disappeared after nutritional nerve treatment;3 cases presented with pleural effusion and were cured after administration of closed chest drainage,anti-infection and strengthening of lung function exercises.51 cases were positive of bacterial culture,including 29 cases of Staphylococcus aureus,17 cases of Es-cherichia coli and 5 cases of Staphylococcus epidermidis.Preoperative ESR,CRP and PCT were 80.9±13.9mm/h,58.4±13.5mg/L,0.8±0.2ng/mL,and before discharge they were 29.6±8.9mm/h,15.0±7.2mg/L and 0.1±0.0ng/mL.ESR,CRP,and PCT were significantly decreased before discharge compared with preoperative values(P<0.05).The patients were followed up for 12-30 months(20.1±4.0 months).At preoperation,before dis-charge and final follow-up,the VAS scores were 7.6±1.1,2.2±0.6 and 1.6±0.6,respectively.Before discharge and final follow-up VAS scores were significantly lower than the preoperative score(P<0.05).The Cobb angle was 19.6°±1.6°,6.2°±1.5°,9.4°±1.0°,and the correction angle was 13.4°±0.6°,the correction rate was 68.7%±5.3%,which was significantly corrected before discharge(P<0.05).At final follow-up,the corrected angle loss was 3.2°±0.7° relative to before discharge,and the corrected angle loss rate was 24.0%±4.6%(P<0.05).At the final follow-up,one patient of preoperative ASIA grade C recovered to grade D,and six patients of grade D recovered to grade E.There was no change in ASLA grade after operation in patients without nerve injury before operation.Bone fusion was achieved in all patients at the final follow-up.Conclusions:On the basis of anti-infection,one-stage posterior approach via multifidus-longissimus cleavage planes for the treatment of thoracolumbar suppurative spondylitis enables removal of lesion,decompression of spinal canal,and fusion and fixation of intervertebral support implants with protection of paravertebral muscles as well as the posterior lig-amentous complexes,and reduces chronic thoracolumbar back pain after operation.

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