Objective: To explore the clinical characteristics, imaging feature, surgical outcomes, and prognosis of recurrent aneurysmal bone cysts (RABC) of the extremities. Methods: Between January 2008 and January 2016, 29 patients histopathologically diagnosed with RABC were treated at our hospital. These patients included 15 males and 14 females. The mean age at the time of diagnosis was 17.4 years(range 4-42 years). The most common site of the RABC was the proximal tibia (12 cases), followed by the distal femur (11 cases), and 3 cases each with involvement of the proximal humerus and the proximal femur. Recurrence was most commonly ob-served within 24 months following the initial treatment. Intralesional re-curettage was performed in 24 patients and en bloc resection of the tumor and reconstruction in 5 patients. The medial tibial stress syndrome (MTSS) score was used to evaluate postoperative func-tion of the affected limb, and the comprehensive clinical efficacy was evaluated on the basis of the Mankin criteria. Results: The mean follow-up duration was 64 months (range 24-90 months). Re-recurrence occurred in 1 patient with a total re-recurrence rate of 3.4%. The postoperative MTSS score was 26-30 points (mean 29.1 points) in the intralesional re-curettage group and 21-27 points (mean 23.0 points) in the tumor resection group. Based on the Mankin criteria, excellent and good clinical outcomes were observed in 95.8% of patients in the intralesional and 60% of the patients in the tumor resection and reconstruction groups. Conclusions: Regular follow-up is essential for the early diagnosis of RABC. The re-recurrence rate following intralesional re-curettage was within an acceptable range, and postoperative limb function was satisfactory; therefore, intralesional re-curettage is the treatment of choice for RABC in-volving the extremities. Tumor resection can be performed in patients with severe articular surface destruction and repeated recur-rence, although long-term complications may occur.

Objective To compare the rigidity at upper thoracic spine among the anterior transpedicular screw-plate system (ATPSPS),posterior transpedicle screw-rod system (PTPSRS) and anterior vertebral body screw-plate system (AVBSPS).Methods Twelve embalmed cadaver specimens were divided into three groups.The specimens in each group were randomly allocated to use the above 3 different internal fixation devices for conducting fixation.The stiffness of each specimen on the directions of axial compression,flexion and extension,and left and right lateral bending was detected under original status.All specimens conducted the simulated corpectomy of T2 (damage status).Then the rigidity on various directions was re-detected on the damage status.The corresponding internal fixation system was selected for conducting the install and fixation according to the grouping results.The intra-group and inter-group rigiditieson different directions were compared amongoriginal status,damage status and after internal fixation.Results The rigidities on different directions under original and damage statushad no statistical difference among various groups (P＜0.05).After conducting fixation in each group,the rigidity after fixation on different directions had statistically significant difference among groups(P＜0.05).The stiffness of anterior flexion in the ATPSPS group was greater than that in the other two groups (P＜0.05).The rigidity of axial compression and extension in the PTPSRS group was greater than that in the other two groups,the difference among groups was statistically significant (P＜0.05).The stiffness of lateral bending in the AVBSPS group was smaller than that in the other two groups,the difference was significant (P＜0.05),but the difference between the other two groups had no statistical significance (P＞0.05).Conclusion The rigidity of ATPSPS in all directions is higher than that of AVBSPS.The anterior flexion rigidity is greater than PTPSRS,and the axial compression and extension rigidity are less than PTPSRS,but the lateral bending rigidity is equivalent to PTPSRS.

Ischemic neurological injury is the most feared complication of spinal deformity surgery.In recent years, more attention has been paid to ischemic neurological injury during spinal deformity surgery including causes, risk factors, and prevention. The direct and indirect causes of ischemic neurological injury contains ligature of the segmental arteries, perioperative bleeding and excessive stretching or shortening of the spinal cord.Those patients at greatest risk for paraplegia following diagnosis of thoracic kyphosis or kyphoscoliosis, unilateral vessel ligation, perioperative hypotension, and extensive anterior and posterior surgery. Keeping reasonable mean arterial pressure and multimodal intraoperative monitoring may effectively prevent ischemic neurologic injury during surgery for spinal deformity.
Arteries ; Humans ; Ischemia ; physiopathology ; Kyphosis ; surgery ; Ligation ; Monitoring, Intraoperative ; Neurosurgical Procedures ; adverse effects ; Paraplegia ; Risk Factors ; Scoliosis ; surgery ; Spinal Cord Injuries

SUMMARY Thehumanembryonicstemcells(hESCs)serveasaself-renewable,genetically-healthy, pluripotent and single source of all body cells,tissues and organs.Therefore,it is considered as the good standard for all human stem cells by US,Europe and international authorities.In this study,the standard and healthy human mesenchymal progenitors,ligament tissues,cardiomyocytes,keratinocytes,primary neurons,fibroblasts,and salivary serous cells were differentiated from hESCs.The human cellular health-safety of NaF,retinoic acid,5-fluorouracil,dexamethasone,penicillin G,adriamycin,lead ace-tate PbAc,bisphenol A-biglycidyl methacrylate (Bis-GMA)were evaluated selectively on the standar-dized platforms of hESCs,hESCs-derived cardiomyocytes,keratinocytes,primary neurons,and fibro-blasts.The evaluations were compared with those on the currently most adopted cellular platforms.Parti-cularly,the sensitivity difference of PM2.5 toxicity on standardized and healthy hESCs derived fibroblasts, currently adopted immortalized human bronchial epithelial cells Beas-2B and human umbilical vein endo-thelial cells (HUVECs)were evaluated.The results showed that the standardized hESCs cellular plat-forms provided more sensitivity and accuracy for human cellular health-safety evaluation.

BACKGROUND:Posterior pedicle screw fixation is an important method to treat various diseases of the spine and to stabilize the spine. Computer navigation system can completely, intuitively and truly reveal the morphology of various tissues and their positions so that the performer can obtain three-dimensional images in time and avoid the risk area of the operation to the utmost, and can directly introduce accurate placement of the screw in the vertebral body. OBJECTIVE:To evaluate the accuracy and safety of computer navigation technique-assisted posterior spinal pedicle screw placement.METHODS:307 patients with spine diseases, who were treated in the First Affiliated Hospital of Guangxi Medical University from July 2008 to January 2014, were enrol ed in this study. They received computer navigation technique-assisted posterior spinal pedicle screw placement and laminectomy for decompression. C-arm fluoroscopy was applied to assess the precision of pedicle screw position during the operation. The mean implantation time per screw and the exposure time to radiation were recorded. 3-day postoperative radiographs and CT examination, which al owed measurements of screw position relative to pedicle position according to Andrew classification, were performed routinely. RESULTS AND CONCLUSION:Of the 1 820 screws inserted by computer-assisted navigation, 1 778 were grade I (accuracy 97.69%). A total of 92 screws were implanted in the cervical vertebrae, including 90 grade-I screws (accuracy 97.82%). 502 screws were implanted in the thoracic vertebrae, including 492 grade-I screws (accuracy 98%). 1 226 screws were implanted in the lumbar vertebrae, including 1 196 grade-I screws (accuracy 97.2%). The mean implantation time per screw was (7.0±1.5) minutes. 215 patients were fol owed up for (12±6) months. No complications such as fixator displacement or breakage or neurovascular injury occurred. Above findings suggested that computer navigation system-assisted spinal pedicle screw implantation provides real-time, multi-perspective, three-dimensional visualization of spinal anatomy, ensures the accuracy and safety of spinal pedicle screw implantation, and apparently reduces exposure time to radiation.

Objectives: To verify the feasibility and safety of the anterior transpedicular screw(ATPS) fixation of the upper thoracic spine (T1-T4) through the radiological anatomy study on the cadaveric specimens. Methods: The upper thoracic spine thin-section CT data of 40 cases were collected from the radiology de-partment′s database(20 males and 20 females, aged from 18 to 68 years, the mean age was 39.7 years). The data of OPW(outer pedicle width), OPH(outer pedicle height), PAL(pedicle axis length), TPA(transverse section angle), SPA(sagittal section angle), DTIP(distance of transverse intersection point) and DSIP(distance of sagittal intersection point) of each pedicle were measured on the transverse and sagittal sections through the axis of each pedicle. The data were recorded and statistically analyzed. 10 upper thoracic spine(C7-T6) specimens of adults(5 males and 5 females, with unknown ages), with no damage to their appearance, the costovertebral joints and paravertebral soft tissue were completely retained. Then simulate surgical operations were done on the cadaveric specimens based on the obtained data. Screws were implanted anteriorly by free hand. After that, the specimens accepted X-ray fluoroscopy and CT scan. At last, the screws were removed, the speci-mens were sawed along the transaction and sagittal section of the screw channel. Then the success rate of the screw placement was evaluated according to Rao′s worn out classification standard of pedicle screws. Results: From T1 to T4, the OPW decreased from 8.14mm to 3.47mm; the OPH increased from 6.89mm to 10.29mm; the TPA decreased from 32.96° to 11.64°; the DTIP increased from 1.80mm to 5.50mm; the SPA increased from 104.95° to 115.74°; the DSIP increased from 5.95 to 8.76mm; the PAL changed irregularly, from 32.95 to 35.96mm. The pedicle diameters of T3 and T4 were too small to implant ATPS, but the ARTPS can be implanted successfully. The diameter of ATPS was about 4.0mm; the length of ATPS was about 35mm. The diameter of ARTPS was about 5.0mm; the length of ARTPS was about 35mm. 80 pedicle screws were implanted anteriorly, according to Rao′s worn out classification standard of pedicle screws, the fine rate was 90%. The internal walls of 7 pedicles were broken by screws of less than 2mm and no compression to the spinal cord. The internal walls of 5 pedicles were broken of 2 to 4mm, 1 at T1, 1 at T3 and 3 at T4, with varying degrees of spinal cord compression. The internal walls of 2 pedicles were broken of greater than 4mm, 1 at T2 and 1 at T4, with serious spinal cord compression. The external wall of 1 pedicle was broken at T2. Conclusions: The ATPS techniques at T1, T2 and the ARTPS techniques at T3, T4 are feasible, but the safety and clinical practice and further research is needed.

Objective To investigate the surgical strategy and outcome for occipitocervical extramedullary tumors.Methods 15 patients with occipitocervical extramedullary tumors from January 2007 to July 2010 were reviewed retrospectively.There were 7 males and 8 females with an mean age of 44.6 years (range,21-72 years).All cases were intradural tumors,including 7 cases in dorsolateral,5 cases in lateral side,and 3 cases in ventralis of spinal cord.Functional and neurological statuses were assessed using the Frankel grade and Japanese Orthopaedic Association (JOA) scale.According to Frankel grade system,there were 4 patients with Grade C,8 with Grade D,and 3 with Grade E.The mean preoperative JOA score was 10.5±3.6.Based on the tumor site,there were 5 cases in medulla oblongata-C1 and 10 cases in C1,2.Frankel grade and JOA score were used to evaluate neurological status and general health.The improvement of symptoms and characteristics of surgical strategies were analyzed.Results All cases were followed up for 2-4 years (mean 2.8 years).Complete resection of tumor and good fusion of bone graft were found in radiography postoperatively.The pathological diagnoses included 10 cases of schwannoma,3 cases of meningioma and 2 cases of neurofibroma.There was statistical difference between the preoperative and the final follow-up functional and neurological statuses including Frankel grade and JOA score.At the latest follow-up,2 cases improved from Frankel grade C to D,2from C to E,6 from D to E,but none in 2 cases with grade D.The mean JOA score at final follow-up was 15.6±1.6,and the average improvement rate was 80.7％± 17.4％.The mean preoperative C0-2 angle was 27.0°±4.1 °,and C2-7 angle was 16.8°± 12.7°.C0-2 angle was 27.6°±8.8°,and C2-7 angle was 10.2°±6.8° at the latest follow-up.However,these differences did not reach statistical significance.Conclusion Surgical treatment can effectively maintain or improve neurological function and improve quality of life.Extramedullary tumors can be resected completely by posterior approach,and spinal stabilization can be obtained satisfactorily through selecting appropriate surgical strategies.For medulla oblongata-C1 level,occipitocervical fusion is usually chosen after extirpation of tumor.For C 1,2 level,C1,2 fusion after tumor resection is useful in preventing atlantoaxial instability.

Objective To investigate the relationship between single nucleotide polymorphisms (SNPs) of PRKCG gene (rs2547362,rs3745406) and osteosarcoma susceptibility in the osteosarcoma patients and the normal population.Methods Sixtyone patients with osteosarcoma who had been admitted in our hospital from January 2011 to December 2012 and 63 healthy adults were enrolled in this study.A 2-ml peripheral blood sample was taken from each participant.The RT-qPCR method was used to detect the genotype and allele frequency distribution of PRKCG gene at rs2547362 and rs3745406 in osteosarcoma patients and normal population.Osteosarcoma patients were divided into several groups according to the clinical parameters such as age,gender,histology,tumor location,Enneking classification,tumor metastasis and therapy,and then we analyzed the relations between the genetic polymorphism and clinical parameters.Results 1) The genotype of PRKCG gene at rs3745406 included CC,CT and TT.The differences of genotypes (CC,CT,TF) and alleles (C,T) frequency distribution at rs3745406 were not statistically significant between osteosarcoma patients and the normal population (P=0.490,P=0.554).2) The genotype of PRKCG gene at rs2547362 included CC,CT and TT.The differences of genotypes (CC,CT,TT) and the alleles(C,T) frequency distribution at rs2547362 were statistically significant between the osteosarcoma patients and the normal population (P=0.006,P=0.007).3) The differences of genotypes (CC,CT,TT) and alleles (C,T) frequency distribution at rs3745406 were statistically significant between patients with metastasis and patients without metastasis (P=0.000,P=0.000).The CT and TT genotypes and the T allele carrier frequency at rs3745406 were higher in patients with metastasis than in patients without metastasis.SNPs at rs2547362 were not associated with clinical parameters.Conclusion The genetic polymorphism of PRKCG gene at rs2547362 is associated with osteosarcoma susceptibility.The TT genotype and T allele at rs3745406 are associated with metastasis of osteosarcoma,which may be a risk factor for metastasis in the osteosarcoma patients.

Objective To explore the clinical characteristics and prognosis of the patients of acute myocardial infarction complicated with heart failure by analyzing the prognostic factors of these patients.Methods This was a single-center prospective study of 349 patients with acute heart failure and ECG documented acute ST elevated myocardial infarction.All patients were treated with primary PCI.After PCI,clinical,angiographic and ECG characteristics,and prognosis of those with preserved (≥50％) or reduced (＜ 50％) left ventricular ejection fraction (LVEF) were assessed.Heart failure patients were divided into two groups:124 with reduced EF (HFREF) and 225 with preserved EF (HFPEF).After 367 days of average follow-up,the primary outcome and number of death were recorded.Results Of them,4 (1.8％) patients in the HFPEF group vs.6 (4.8％) in the HFREF group died.The difference in rate of death between two groups was not significant (P =0.314).There were significant difference in main adverse cardiac and cerebra vascular events (MACCE) occurred during follow-up period between the two groups (P =0.022).The Killip Classification of heart failure (HR =1.092,95％ CI 1.040 ～ 1.149,P ＜0.01) was significantly related to the death rate during follow-up.Conclusions The independent factors affecting prognosis in patients with acute heart failure after coronary revascularization were closely consistent with the stratums of the Killip Classification.Patients with HFPEF had a similar prognosis as those with HFREF after primary stenting.

Objective: TO evaluate the effect of custom-made artificial total knee prosthesis replacement on pathological fracture of distal femur caused by giant cell tumor of bone. Methods." A total of 12 knees of 12 patients with pathological fracture of distal femur caused by giant cell tumor of bone were treated with cus-tom-made artificial total knee prosthesis replacement. There were 5 males and 7 females aged from 23 to 40 years (34.2 years on average). Results: All patients tolerated surgery very well. The surgical duration was 120～ 180 rain and the intraoperative bleeding was 500 ～ 900mL. The drainage tube was taken out in 5 days after surgery. The postoperative drainage volume was 300 ～ 700mL. There were no postoperative complica-tions. The postoperative X-ray examination showed that all of the prosthesises were in the right position. Lo-cal pain disappeared in all patients after surgery. The pathological examination identified all the patients with giant cell tumor of bone. All patients were followed up for 18 ～ 30 months (24 months on average). No recur-rence was observed after surgery. No infection or implant loosening occurred during the follow up. According to the Enneking assessment system of function after limb salvage surgery, the mean Enneking scale was 23.8 points (ranged from 15 to 28 points) at the last follow-up visit. Conclusion: Custom-made artificial total knee prosthesis replacement can achieve a high satisfactory rate in clearance of lesion and restoring function of the knee in patients with pathological fracture of distal femur caused by giant cell tumor of bone, improving patients' quality of life.