Analysis of the technical key points and clinical effect of full-endoscopic lumbar annulus fibrosus suture / 中国骨伤

OBJECTIVE@#To introduce the technical key points of lumbar annulus fibrosus suture under full-endoscope and analyze the clinical efficacy of full-endoscopic lumbar discectomy and annulus fibrosus suture.@*METHODS@#A total of 50 patients with non contained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture in our department between January 2018 and November 2018 were included. Full-endoscopic single-stitch suture through transforaminal approach or double-stitch suture through interlaminar approach was selected according to lesion level. The lumbar MRI and CT were reexamined on the second day and 3 months after surgery to evaluate the completeness of the discectomy and the adequacy of nerve decompression respectively. The patients were followed up on the second day, 3 months, 6 months, and 1 year after surgery for pain relief using visual analogue scale (VAS, 100 -point scale). The patients were followed up at 3 months, 6 months, and 1 year postoperatively for the recovery of lumbar spine function using Oswestry Disability Index(ODI). At the 1-year follow-up, the Macnab standard of lumbar spine function was evaluated, and the recovery of nerve root function (sensory, muscular and reflex) was recorded.@*RESULTS@#All operations were successfully completed, of which 27 patients were treated with transforaminal approach(including 8 cases of L and 19 cases of L), and 23 patients(including 11 cases of L and 12 cases of LS) with interlaminar approach. The average operation time was 43.2 minutes. There were no surgical complications and no recurrence of lumbar disc herniation. Postoperative lumbar MRI and CT examinations of all patients showed that the herniated disc was completely removed and the nerveswere fully decompressed. All patients had significant relief of low back pain and lower extremity radiation pain, and the ODI score improved significantly(0.05).@*CONCLUSION@#Full-endoscopic lumbar discectomy and annulus fibrosus suture are safe and effective techniques for minimally invasive spinal surgery, which can reduce the recurrence rate of lumbar disc herniation after full endoscopic lumbar discectomy.

Brain-computer Interface and Comprehensive Training for Stroke: A Resting State Functional Magnetic Resonance Imaging Study / 中国康复理论与实践

Objective:To investigate the topological alterations in brain functional networks following comprehensive treatment including brain-computer interface (BCI) training in subacute stroke subjects. Methods:From January, 2018 to June, 2019, 14 subacute stroke patients with moderate to severe upper limbs paralysis accepted routine physical therapy, occupational therapy and BCI training based on motor imagery, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT) before and after treatment, while the functional connectivity (FC) was investigated with resting state functional magnetic resonance imaging. Results:The scores of FMA-UE, ARAT and WMFT increased after treatment (|t| > 5.298, Z = -3.297, P < 0.01). The FC also increased across the whole brain, including temporal, parietal, occipital lobes and subcortical regions. The FC between left piriform cortex of parietal lobule (BA5L) and right medial surface of temporal lobe (BA48R), as well as those between left precentral gyrus (BA4L) and right anterior transverse temporal gyrus (BA41R) (r > 0.416, P < 0.05). Conclusion:Comprehensive rehabilitation including BCI training may promote recovery of motor function and activities of FC in brain in subacute stroke patients.

Preoperative evaluation value of carotid and cerebral arteries by CT angiography in acute type A aortic dissection / 医疗卫生装备

Objective To investigate the feasibility of combined CT angiography(CTA)of head,neck and aorta in acute type A aortic dissection (ATAAD) and whether the incremental craniocervical information benefits the surgeon and leads to improved clinical outcomes.Methods One hundred and twenty ATAAD patients in a CAC group underwent combined aortic CTA and 123 ATAAD patients in a control group underwent conventional aortic CTA.In the CAC group,the image quality was analyzed and critical CTA findings in craniocervical arteries were determined for further surgery procedure.The radiation dose,intraoperative cerebral protection method,and postoperative intensive care units(ICU)time,in-hospital time,neurologic dysfunction(ND)and all-cause mortality were compared between the two groups.Results The CAC group had all the carotid and cerebral arteries diagnosed successfully. There were 13 patients replaced conventional unilateral antegrade selective cerebral perfusion with bilateral one according to the head and neck CTA images in the CAC group. The CAC group had effective radiation dose,postoperative ND,ICU time and in-hospital time significantly lower than those of the control group (P<0.05).There were no statistical differences between the all-cause morbidities of the two groups (P>0.05).Conclusion A combined CTA of head, neck and aorta in ATAAD is feasible. The incremental craniocervical information may lead to improved clinical outcomes.

Imagings of coronary total occlusion using dual-source computed tomography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the imaging characteristics of coronary arteries with total occlusion (TO) lesions shown by dual-source computed tomography CT (DSCT) coronary angiography.</p><p><b>METHOD</b>The clinical data of patients who were diagnosed as coronary heart disease together with total occlusion lesions between March 2008 and March 2010 were retrospectively analyzed.</p><p><b>RESULTS</b>In a cohort of 140 patients with 152 TO lesions, TO vessels in right coronary artery, left anterior descending artery, left circumflex coronary artery, or left main coronary artery were 68, 48, 20, and 1, respectively. Side branch TO were found in 15 vessels, in which 13 cases were found to be with TO in two coronary arteries. The length of TO was 5-58 mm, mean (16.8 ± 3.9) mm. TO lesions with a length ≥ 1 cm accounted for 91.4%. The appearance of stump in TO were abrupt occlusion (n=68) , blunt occlusion (n=64) , and mouse-tail occlusion (n=20) . Among all the TO lesions, 73% were soft plaque or mainly soft plaque together with minimal calcification. Mixed plaque and calcified plaque were less seen. Ten TO segments presented with dilated lumens were thrombogenesis. There were 25 TO segments angulated or tortuosity, which were most frequently shown in right coronary artery. DSCT only presented 3 TO with clear collateral vessels and no TO with bridge collateral vessels was shown.</p><p><b>CONCLUSIONS</b>DSCT can provide most necessary information of coronary TO lesions. Therefore, it can be used to guide surgeries on TO lesions and improve the success rates of surgeries.</p>

Soluble expression of recombinant human apoliprotein A-I-Milano in Escherichia coli / 生物工程学报

Apolipoprotein A-I-Milano(AIM), a natural variant, not only inhibits the initiation and progression of atherosclerosis, but also makes the preexisting atherosclerotic lesions regress. AIM gene, at which N-terminal codens were optimized, was subcloned into the expression vector of pET22b. Recombiant plasmids were transformed into E. coli strain BL21 (DE3) and induced with IPTG. The expressed apoliprotein A-I-Milano was soluble in E. coli and was about 38% of total cell lysate. Purified by Butyl Sepharose 4F. F hydrophobic chromatography and Q Sepharose H.P. anion exchange chromatography, followed by ultrafiltration with Vivaspin 20 (30 000MW), AIM monomer was obtained in a purity of more than 95%. Activity assay of binding of AIM monomer to lipid indicates that association of AIM monomer with DMPC is slower than normal apoA-I but DMPC number associated by AIM monomer is more than by apoA-I. This results will be important for studying structure, function of AIM, specially clinical application.

Purification and activity assay of HSA-AX15 (R13K) fusion protein expressed in Pichia pastoris / 生物工程学报

To increase the in vivo half-life of human CNTF mutein AX15 (R13K), HSA-AX15 (R13K) fusion protein was constructed by the fusion of the C-terminus of HSA to the N-terminus of AX15 (R13K) via an 11 amino acids linker. HSA-AX15 (R13K) fusion protein was purified to homogeneity by cation exchange chromatography, reverse phase chromatography and gel filtration after expressed in pichia pastoris. TF-1 cell survival bioassay showed the biological activity of AX15 (R13K) was not affected by the fusion to HSA. It was demonstrated that tertian injection of 4.8 mg/kg HSA-AX15 (R13K) fusion protein could produce more potent anti-obesity effects on KM mice than daily injection of 1.6 mg/kg AX15 (R13K). The long-acting form of hCNTF variant has the potential to reduce discomfort by requiring fewer injections and to minimize the side-effects by decreasing the dosage and fluctuation of plasma concentration, and thus has superior clinical application.

Construction of protease resistant mutein of human CNTF and its expression in Pichia pastoris / 生物工程学报

AX15 is a mutein of naturally occurring human ciliary neurophic factor (hCNTF), with improved biological activity, stability and solubility. AX15 is susceptible to protease degradation when expressed in Pichia pastoris. Amino acid sequencing revealed the degradation was occurred behind position 12 and 13 amino acid residues, which constitute a dibasic site, RR. Based on the substrate specificity of KEX2, a KEX2 resistant mutein of AX15-AX15 (R13K) was constructed, in which RR was replaced by RK. It was demonstrated that the stability of AX15 (R13K) improved significantly, as no degradation was detected even after 120 hours of induction. AX15 (R13K) was purified to homogeneity by ultrafiltration and gel filtration. TF-1 cell survival bioassay showed AX15 (R13K) had equivalent specific activity to AX15. The protease resistant mutein of AX15 may have greater in vivo stability and thus have superior therapeutic potential.

High expression and characterization of human parathyroid hormone in Escherichia coli / 生物工程学报

Human parathyroid hormone (hPTH) was highly expressed in Escherichia coli by inserted the synthesized whole hPTH cDNA into the vectors pBV220 and pET22b. After expression and disruption, the purified product was acquired through cation exchange chromatography and reverse phase chromatography. From the results of N-terminal sequencing and MALDI-TOF-MS analysis the recombiant prtein was indentified as intact hPTH. In in vitro Bioassays the recombinant hPTH stimulated adenylate cyclase as the standard did. In ovariectomized rats the recombinant hPTH markedly increased the femoral bone mass and bone mineral density.