Objective To investigate the relationship between clinical efficacy and cage subsidence,and to identify the risk factors of cage subsidence after transforaminal lumbar interbody fusion (TLIF) in treating single level lumbar disc herniation and lumbar spondylolisthesis.Methods According to the inclusion/exclusion criteria,a series of 107 patients who underwent TLIF with polyetheretherketone (PEEK) cage in our department were evaluated retrospectively between May 2011 and May 2014.Intervertebral space height and segmental angle were measured on the preoperative and postoperative iconography according to the metrical software.All patients were divided into cage subsidence group (cage subsidence ≥ 2 mm) and cage non-subsidence group (cage subsidence ＜ 2 mm) based on the threshold value of intervertebral space height via X-ray.The Oswestry disability index (ODI) and visual analogue scale (VAS) was used to evaluate the clinical efficacy.Univariate analysis and logistic regression analysis were performed to identify the potential risk factors.Results Of all 107 patients,thirty-six patients (15 males and 21 females)aged 52.61 ± 13.82 years were divided into in the cage subsidence group with an average follow-up duration 26.33±7.66 months,seventy-one patients aged 53.80± 14.94 years,28 males and 43 females in the cage non-subsidence group,were followed-up for 23.82±8.95 months.There was no significant difference between cage subsidence group and cage non-subsidence group in gender,age,course of disease and time of follow-up (P＞ 0.05).The average 2.79±0.78 mm (range 2.02-5.53 mm) subsidence was observed in cage subsidence group.The preoperative intervertebral space height,postoperative intervertebral space height,postoperative segmental angle were related to cage subsidence by univariate analysis (P ＜ 0.05).Postoperative intervertebral space height [OR=1.864,95％CI(1.207,2.879) mm] was the risk factor of cage subsidence by logistic regression (P ＜ 0.05).There was no significant difference between cage subsidence group and cage non-subsidence group in ODI and VAS (P ＞ 0.05).Conclusion Cage subsidence is affected by the preoperative intervertebral space height,postoperative intervertebral space height,and postoperative segmental angle.Postoperative intervertebral space height is the independent risk factor of cage subsidence.Over distraction of intervertebral space height could increase the risk of cage subsidence.

Background and purpose:Adenosine triphosphate-binding cassette superfamily G member 2 (ABCG2), which has been found over-expressed in a variety of cancer cells, takes part in the drug resistance of cancer through effux of anticancer drugs. The purpose of this study was to investigate the mechanisms of human glioblastoma cells sensitivity to pyropheophorbide-a methyl ester (MPPa)-mediated photodynamic therapy (PDT) eradicating tumour cells and its relationship to ABCG2.Methods:U87 and A172 glioma cell lines in the logarithmic growth phase were selected and exposed to the treatment of MPPa-PDT and MPPa-PDT+fumitremorgin C (FTC) respectively. The cell viability was measured with the use of CCK-8 assay. The expression of ABCG2 was detected by Western blot. The intracellular contents of MPPa in each group without illumination were tested by lfow cytometry. Flow cytometry with AnnexinⅤ-FITC/PI double staining was used to detect the cell apoptotic rate. DCFH-DA staining was used to assess the generation of intracellular reactive oxygen species (ROS).Results:The MPPa-mediated PDT could eradicate A172 and U87 cancer cells in an energy-dependent manner. The light energy density in A172 was 8 times of that in U87 when the cell viability reached median lethal dose after MPPa-mediated PDT. The high expression of ABCG2 in A172 cells affected the accumulation of intracellular MPPa. Inhibition of ABCG2, not only could enhance the eradicating effect of MPPa-PDT on A172 cells, but also could increase the yield of ROS triggered by MPPa-PDT and the accumulation of intracellular MPPa.Conclusion:The human glioblastoma cell line A172 is insensitive to MPPa-mediated PDT. The mechanism may relate to ABCG2, which decreases the MPPa content in cancer cells through effux of MPPa, resulting in decline of cytotoxicity.

Objective To evaluate the feasibility and clinical effect of stage Ⅰ posterior vertebral corpectomy filled with titanium mesh cages plus long-segmental instrumentation for treatment of Denis type D and E severe unstable thoracolumbar burst fracture.Methods A retrospectively review was made on 14 patients with Denis type D and E severe unstable thoracolumbar burst fracture,having had posterior vertebral corpectomy,titanium mesh bone grafting and long-segmental pedicle screw fixation.Parameters recorded were operation time,amount of bleeding,bone fusion and reduction,postoperative complications,low back pain,neurological performance,restoration and loss of anterior vertebral height,correction and loss of kyphosis,and intraspinal space occupying lesion.Results Mean operation time was 207.1 min (range,148-306 min) and blood loss was 585 ml (range,300-1,500 ml).Intraoperative fracture reduction was satisfactory.Follow-up ranged from 18 to 54 months (mean,28 months),which showed no complications of infection,screw-rod breakage,loosening or shifting of the internal fixation device,titanium mesh subsidence and pseudarthrosis,and no signs of adjacent segment degeneration.Six months after operation,CT scan showed bony fusion of the bone-implant interface.At the final follow-up,the Denis pain scale improved significantly including 12 patients with completely relieve of pain (P1) and 2 ache slightly but no need of taking painkiller (P2).Neurological functions were improved by 1-3 degree in all patients.Percentage of anterior vertebral height was (41.2 ± 8.9)％ before operation,significantly reduced to (8.3 ± 4.8) ％ one week after operation and to (8.9 ± 5.1) ％ at the final follow-up (P ＜0.01).Mean loss of anterior vertebral height was 0.6％.Sagittal kyphotic angle was (36.9 ± 4.9) °before operation,significantly reduced to (8.1 ± 3.4) ° one week after operation and (8.5 ± 3.8) °at the final follow-up (P ＜0.01).Mean loss of kyphotic angle was 0.9°.Ratio of intraspinal space occupancy was (74.9 ± 11.3) ％ before operation but recovered to (4.1 ± 1.6) ％ one week after operation and (1.8 ± 1.4) ％ at the final follow-up,with significant differences in pair comparison (P ＜ 0.01).Conclusion The use of posterior vertebral corpectomy and fusion with titanium mesh cage fusion in conjunction with long-segment instrumentation are effective for spinal canal decompression,fracture reduction,three-column reconstruction as well as rigid fusion at one stage,lumbar pain relief,neurological function recovery,prevention of correction loss and vertebral height restoration.

The present study is aimed to investigate the early clinical effects of nano-hydroxyapatite/polyamide 66 intervertebral fusion cage (n-HA/PA66 cage) for the treatment of lumbar degenerative diseases. We selected 27 patients with lumbar degenerative diseases who were managed by posterior decompression or reset operation combined with n-HA/PA66 cage intervertebral fusion and internal fixation from August 2010 to January 2012. The oswestry disability index (ODI), low back and leg pain visual analogue score (VAS), and intervertebral height (IH) were evaluated at preoperation, 1 week postoperation and the last follow-up period, respectively. Intervertebral bony fusion was evaluated at the last follow-up time. The patients were followed up for 12-24 months (averaged 19 months). The ODI, VAS and IH were significantly improved at 1 week postoperation and the last follow-up time compared with those at preoperative period (P < 0.05). But there was no significant difference between 1 week postoperative and the last follow-up time (P < 0.05). Brantigan's standard was used to evaluate fusion at the last follow-up time. There were 19 patients with grade 5 fusion, 8 with grade 4 fusion, with a fusion rate of 100%, and none with grade 1-3 fusions. There was no cage translocation and internal fixation breakage. These results suggested that n-HA/PA66 cage was an ideal biological material in the posterior lumbar interbody fusion and internal fixation operation for treatment of lumbar degenerative diseases. It can effectively maintain the intervertebral height and keep a high rate of bony fusion. The early clinical effect has been satisfactory.
Back ; Decompression, Surgical ; Durapatite ; Follow-Up Studies ; Fracture Fixation, Internal ; Humans ; Lumbar Vertebrae ; Nanostructures ; Nylons ; Spinal Fusion ; Treatment Outcome

ObjectiveTo investigate the adjuvant effect of heatshock protein 110(HSP110) on the immune responses induced by an altered peptide ligand of human papilloma virus type 16 E711-20 peptide (HPV16E711-20).Methods The complex of HSP110 and an altered peptide ligand of HPV16E711-20 was constructed in vitro.Fifteen 6-week-old C57BL/6 female mice were randonly and equally divided into 3 groups,including complex group,ligand group,and phosphate buffered solution (PBS) group,to receive intraperitoneal immunization with the complex (100 μg),peptide (10 μg),and PBS (100 μl) respectively.Immunization was carried out with an interval of 2 weeks for 2 times.Two weeks after the last immunization,the mice were sacrificed followed by the isolation of splenocytes.MTT assay was performed to evaluate the proliferation activity of splenocytes,intracellular staining for interferon(INF)-γ to detect cytotoxic T lymphocytes (CTLs),standard chromium-51 (51Cr) release assay to estimate the lethal effect of specific CTLs on target cells.Statistical analysis was performed by using t test with SPSS 10.0 software.Differences were considered as statistically significant when the P value was less than 0.05.ResultsA significant increase was observed in the proliferation index ( 1.87 ± 0.122 vs.0.32 ± 0.071,t =4.01,P ＜ 0.01 ) of,and percentage of CD8+IFN-γ+ T lymphocytes(3.9％ vs.0.4％,t =3.88,P ＜ 0.01 ) among splenocytes from the complex group compared with the ligand group.At the effector-to-target ratio of 100 ∶ 1,50 ∶ 1,25∶ 1 and 12.5 ∶ 1,the death rate of target cells was 54.7％,72.2％,61.5％ and 39.8％ respectively after incubation with CTLs from the compleximmunized mice,higher than that from the ligand-immunized mice (35.2％,49.3％,28.1％,17.4％,respectively).ConclusionHSP110 could enhance the immunological effect of the altered peptide ligand of HPV16E711-20,and can serve as an immunological adjuvant.

For better adaptation to clinical work and scientific research as well as self-development,medical postgraduates are required to improve their reading ability to harvest information from medical English articles.Constructing formal schema based on linguistic schema and enriching content schema can significantly enhance medical English reading ability,according to schema theory and education practice.Therefore,the learning mode was explored based on schema theory and this theory was applied in practice to elevate reading ability by means of reading report.

Objective To evaluate the outcome of reoperation(after I stage anterior/posterior operation)for thoracolumbar fractures combined with kyphosis and spinal cord injury. Methods A retrospective study was done on the medical records of 12 patients who underwent two-stage decompression with kyphosis and neurologic deficit due to single-stage approach(anterior or posterior) operation of thoracolumbar fractures combined with spinal cord injury between January 2005 and April 2009.There were 9 males and 3 females,at mean age of 34.6 years(range,19-57 years).According to the Denis classification,there were five patients with burst fractures,five with compression fractures and two with fracture dislocation.All the patients had couns medullaris injury.Of all the patients,five underwent one stage anterior approach surgery and the others underwent posterior approach operation.All the patients had vailous degrees of neurological symptoms.The patients treated with one stage anterior surgery were treated with two stage posterior surgery and the patients treated with one stage posterior surgery were treated with the two stage anterior operation.The mean interval from one stage operation to two stage decompression was 13.4 months(range,12-18 months).The radiologic,neurologic and functional outcomes were assessed through observation of the Cobb angle,Frankel spinal cord injury grading and Japanese Orthopaedic Association Scores(JOA). Results AIl the patients were followed up for mean 25 months (12-48months),which showed primary healing of the incisions in all the patients.The average anterior and posterior heisht of the vertebrae wers corrected from preoperative 42.6%and 70.5%to postoperative 92.5%and 95.7%and to 87.3%and 92.2%at the final follow-up respectively.Neurologic status was improved at least one Frankel grade in the patients who had preoperative incomplete paraplegia.The Cobb angle was corrected from preoperative 36.3°to postoperative 5.8°and to 5.9°at the final follow-up(P<0.05).No patient had any notable loss of correction between discharge and final follow-up.According to JOA coring,the results were excellent in nine patients,good in two and fair in one,with excellence rate of 92%. Conclusions Two stage decompression for epiconus and cauda equina syndrome resulted from one stage approach(anterior or posterior)operation of thoracolumbar fractures combined with spinal cord injury call attain satisfactory correction of the kyphosis and nerve decompression as well as various degrees of nerve function recovery.

Objective To develop and validate a novel method of atlantoaxial pedicle screw placement by using three-dimensional reconstruction software Mimics and rapid prototyping. Methods Three-dimensional reconstruction of 20 CT scanned cadaver atlantoaxial specimens was performed by using Mimics and the parameters of the pedicles were measured. Then, physical model of the pedicles was manufactured by using rapid prototyping and the parameters of the cadaver pedicles were measured. The parameters of the atlantoaxial pedicle were directly measured. All the data were analyzed statistically to verify the accuracy of the reconstructed images and physical models. The optimal pedicle channel was found to design individual fixation parameters, based on which fixation of cadaver specimens was performed under direct guidance of physical model. The accuracy of fixation was assessed by CT scanning. Results There was no statistical difference in parameters of the reconstructed images, the physical model and the specimens, which could reflect accurate atlantoaxial anatomy. Postoperative CT scanning showed that the pedicle screws were inserted successfully in 16 sides of four specimens, except for one screw wearing medial bone cortex of the atlas artery. Conclusions Three-dimensional reconstruction of the atlantoaxial specimens by using Mimics and physical models made by rapid prototyping technology facilitate atlantoaxial pedicle screw placement and can enhance the accuracy of screw fixation.

Objective To investigate the immunogenicity of immunodominant cytotoxic T lymphocyte epitope E749-57 of human papilloma virus (HPV) 16 oncoprotein E7 chaperoned by heat shock protein (HSP)110. Methods Mouse HSP110 gene was cloned into prokaryotic expression vector pQE-80L for the expression of HSP110 protein, which was purified using Ni-NTA column. SDS-PAGE and Western-blot were conducted to confirm the purified mHSP110 protein, which was subsequently incubated with E749-57 peptide under heat shock condition, and high-performance liquid chromatography (HPLC) was used to evaluate the binding efficiency of the recombinant protein and E749-57 peptide. Twenty mice were divided into 4 groups to be immunized with mHSP110 protein, E749-57 peptide, mHSP110-E749-57 complex and phosphate buffered saline (PBS),respectively. Two weeks after the last immunization, spleen cells were collected from the immunized mice and divided into 2 parts: one were stimulated by E749-57 peptide followed by the detection of CD8+ INF-γ+ T cells with flow cytometry; the other one were subjected to MTT analysis for the estimation of cell proliferation. The mHSP110-E749-57 complex was also used to immunize TC-1 tumor bearing mice to observe its anti-tumor effect.Results The full-length 2577 bp-sized mHSP110 gene was amplified from mouse liver cDNA and cloned into pQE-80L vector. Direct sequencing confirmed the correctness of the cloning. SDS-PAGE and Western-blot demonstrated the successful purification of mHSP110. HPLC assay showed that the purified mHSP110 protein could bind with E749-57 to form a relatively stable protein complex. The percentage of IFN-γ+ CD8+ T cells in and proliferation index of spleen cells from the complex-immunized mice were statistically higher than those from the other 3 groups of mice. Moreover, the complex could obviously inhibit the growth of TC-1 tumor in mice. Conclusion The mHSP110-E749-57 complex could enhance the generation of specific cytotoxic T lymphocytes and exert anti-tumor effects in mice.

This study was aimed to evaluate the preliminary efficacy and the safety of the fusion cage made of biomimetic nano-hydroxyapatite and polyamide 66 (n-HA/PA66) composites for the structural reconstruction and the restoration of height of vertebral body in the case of cervical spondylosis by anterior surgical procedures. 52 patients with cervical spondylosis, received the therapy by discectomy with or without vertebrae resection and decompression, and the fusion cage of n-HA/PA66 vertebra implant with bone chip, and titanium plate system was fixed. All cases were followed up for 6 to 25 months. All the patients' preoperative symptoms subsided without any serious complication, and no patient complained of lasting soreness. No effusion or flare was found, and no recurrence happened in the follow-up. The preoperative JOA score was 10.4, and post-operative JOA score 15.7. The X-ray films of all cases demonstrated successful fusion with good curvature and height, and there was no sinking or collapse. The stability was satisfactory; the reconstructive height of vertebra was maintained. No complications such as infection and screw broken came into being. The fusion cage of the biomimetic n-HA/PA66 composites can effectively restore the height and structure of vertebra. It may have the potential for use as a satisfactory prosthestic vertebral body replacement.
Adult ; Aged ; Biocompatible Materials ; therapeutic use ; Biomimetics ; Cervical Vertebrae ; pathology ; surgery ; Female ; Humans ; Hydroxyapatites ; Male ; Middle Aged ; Nanoparticles ; Nylons ; Orthopedic Fixation Devices ; Spinal Fusion ; instrumentation ; methods ; Spondylosis ; surgery ; Young Adult