Investigation on Rehabilitation Therapists Practitioners under Medical-Exercise Integration in China / 中国康复理论与实践

Objective:To investigate the integration of medicine and exercise in China in rehabilitation therapists practitioners. Methods:From May to June, 2019, rehabilitation therapists in provincial and municipal medical institutions, health management centers and rehabilitation institutions nationwide were surveyed with Wenjuanxing online questionnaires, which included basic information, geographical distribution, nature of work units, occupational characteristics, educational background, years of working and awareness of exercise prescriptions. Results:A total of 2935 rehabilitation-related employees were involved, which included 1387 male and 1548 female in 31 provinces. In all the respondents, 1505 of them (51.28%) worked in tertiary hospitals and 1015 (34.58%) in secondary hospitals; 2182 (74.34%) worked on physical therapy, 947 (32.27%) on occupational therapy, 553 (18.84%) on speech therapy, 141 (4.80%) on rehabilitation engineering, and 846 (28.82%) on exercise rehabilitation; 2218 (75.57%) were with junior title and 592 (20.17%) with intermediate title; 24 (0.82%) were with secondary school education, 724 (24.67%) with junior college degree, 2011 (68.52%) with bachelor's degree, and 160 (5.99%) with master's degree or above; 785 (26.75%) fully understood, 1025 (34.92%) understood and 1009 (34.38%) basically understood the concept of exercise prescription. Conclusion:Rehabilitation therapy is widely spread in China, however, the geographical distribution is uneven. Rehabilitation related practitioners are diversified in professional direction, and full-time job is not top-notch. The level of education is generally low, and talent cultivation needs to be strengthened. The integration of medicine and exercise is developing, and exercise prescriptions are widely available. It is necessary to cultivate a considerable number of high-quality professionals to coordinate the integrated development of medicine and exercise, to improve the quality of rehabilitation services and promote the development of medicine and exercise integration.

Recent Advances in Technique and Clinical Outcomes of Minimally Invasive Spine Surgery in Adult Scoliosis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis.</p><p><b>DATA SOURCES</b>We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: "minimally invasive," "spine," "surgery," and "scoliosis."</p><p><b>STUDY SELECTION</b>The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies.</p><p><b>RESULTS</b>The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3-7, operative time was 2.3-8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications.</p><p><b>CONCLUSIONS</b>MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.</p>

Lumbar Scoliosis Induction in Juvenile Dogs by Three-dimensional Modulation of Spinal Growth Using Nickel-Titanium Coil Springs / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Current treatments for scoliosis have some defects and complications. To study spinal deformities and test novel scoliosis treatments, many animal models of scoliosis have been developed. These models applied a single load to the spine and could not precisely modulate the spinal growth in different dimensions. In this study, we applied posterior tethering in various directions with the application of nickel-titanium (NT) coil springs in dog's spine to modulate spinal growth in the coronal, sagittal, and transverse planes and create a scoliosis model possess curves that mimic adolescent idiopathic scoliosis (AIS) three dimensionally.</p><p><b>METHODS</b>Scoliosis was surgically induced in eight 8-week-old female dogs (weight: 1.95-2.30 kg) using bone screws and NT coil springs. The deformity was induced through the placement of posterior NT coil springs that tethered the spine by bone screw fixation. All dogs were monitored with serial radiographs to document changes in deformities.</p><p><b>RESULTS</b>All experimental animals developed scoliotic curves convex to the left in the lumbar segment. The mean coronal Cobb angle was 18.0° immediately postoperatively and 54.5° at 22 weeks. The mean lordosis increased from 6.2° postoperatively to 35.0° at final follow-up. Apical axial rotation increased from 4.5° postoperatively to 31.2° at 22 weeks.</p><p><b>CONCLUSIONS</b>With the application of NT springs in dogs that allowed posterior tethering in various directions, lumbar spinal deformity was achieved in three planes: coronal, sagittal, and transverse planes. Notably, the lumbar spine in surgically treated dogs developed lordoscoliosis with obvious rotation and the curves mimic AIS three dimensionally well. This method allows lumbar scoliosis to develop without deep dissection of muscle and maintains the essential anatomical elements along the spinal curve. Moreover, the spinal growth modulation technique could yield information that would provide a basis for developing novel early-stage treatments for children with scoliosis.</p>

Reliability of a novel Cobb protractor for measuring the Cobb angle of radiograph in scoliosis / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To introduce a novel Cobb protractor and assess its reliability and rapidity for measuring Cobb angle in scoliosis patients.</p><p><b>METHODS</b>The novel Cobb protractor had two endplate markers. A measurement was performed just to align the two markers to each endplate of the curve. The Cobb angle on the posteroanterior radiographs of 24 patients clinically diagnosed with adolescent idiopathic scoliosis was measured by three orthopedic surgeons with both standard Cobb method and the new technique, and the time of measurement was recorded. Intraclass correlation coefficients (ICCs) were calculated to assess the reliability of the new method.</p><p><b>RESULTS</b>The time for a measurement with the new tool was approximately 10 seconds less than the time that used to finish a measurement with the standard method (P<0.05). The overall mean Cobb angle for the major curve of the 24 patients was 47.8°. The mean overall intraobserver and interobserver ICC was 0.971 and 0.971 for the Cobb method group, while the overall intraobserver ICC and the interobserver was 0.985 and 0.979 for the new tool group.</p><p><b>CONCLUSIONS</b>The novel Cobb protractor could perform quick measurement and measure almost all forms of radiographs. The Cobb protractor might be an ideal instrument to measure the Cobb angle.</p>

Drainage does not promote post-operative rehabilitation after bilateral total knee arthroplasties compared with nondrainage / 中国医学科学杂志(英文版)

<p><b>UNLABELLED</b>OBJECTIVE To assess the effects of suction drainage versus nondrainage on the post-operative rehabilitation of patients receiving primary bilateral total knee arthroplasties (TKA).</p><p><b>METHODS</b>A prospective study including 40 patients was conducted. These patients were diagnosed with osteoarthritis and underwent primary bilateral TKA between October 2007 and September 2009 with the same operation team. A suction drainage was placed by randomization in only one knee for each patient, while the other knee as self-control. Pain visual analogue scale score, extremity swelling, wound healing, range of motion and incidence of early post-operative complications between the drained and nondrained group were compared statistically.</p><p><b>RESULTS</b>Each patient was followed up for 12 months. Placing drainage did not relieve the pain, extremity swelling, ecchymosis, or reduce the incidence of early complications (all P>0.05).</p><p><b>CONCLUSIONS</b>Suction drainage in TKA does not exhibit substantial advantages in promoting post-operative rehabilitation after unsophisticated TKA, compared with nondrainage. On the other hand, it might complicate the surgical operation, and increase the incidence of post-operative hemorrhage and retrograde infection. Thus we do not recommend suction drainage in unsophisticated TKA.</p>

Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transforaminal lumbar interbody fusion (TLIF) through a minimally invasive approach (mTLIF) was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF (oTLIF), but inconsistent outcomes were reported.</p><p><b>METHODS</b>We conducted a meta-analysis to evaluate the effectiveness of mTLIF and oTLIF in the treatment of degenerative lumbar disease. We searched PubMed, Embase and Cochrane Database of Systematic Reviews in March 2013 for studies directly comparing mTLIF and oTLIF. Patient characteristics, interventions, surgical-related messages, early recovery parameters, long-term clinical outcomes, and complications were extracted and relevant results were pooled.</p><p><b>RESULTS</b>Twelve cohort studies with a total of 830 patients were identified. No significant difference regarding average operating time was observed when comparing mTLIF group with oTLIF group (-0.35 minute, 95% confidence interval (CI): -20.82 to 20.13 minutes). Intraoperative blood loss (-232.91 ml, 95% CI: -322.48 to -143.33 ml) and postoperative drainage (-111.24.ml, 95% CI: -177.43 to -45.05 ml) were significantly lower in the mTLIF group. A shorter hospital stay by about two days was observed in patients who underwent mTLIF (-2.11 days, 95% CI: -2.76 to -1.45 days). With regard to long-term clinical outcomes, no significant difference in visual analog scale score (-0.25, 95% CI: -0.63 to 0.13) was observed; however, there was a slight improvement in Oswestry Disability Index (-1.42, 95% CI: -2.79 to -0.04) during a minimum of 1-year follow-up between the two groups. The incidence of complications did not differ significantly between the procedures (RR = 1.06, 95% CI: 0.7 to 1.59). Reoperation was more common in patients in mTLIF group than in oTLIF group (5% vs. 2.9%), but this difference was not significant (RR = 1.62, 95% CI: 0.75 to 3.51).</p><p><b>CONCLUSION</b>Current evidence suggests that, compared with traditional open surgery, mTLIF reduces blood loss and allows early postoperative recovery, while achieving comparable or slightly better long-term outcomes, and with a comparable risk of complications.</p>

Advances in minimally invasive spine surgery in treatment of adolescent idiopathic scoliosis and adult scoliosis / 中国医学科学院学报

The traditional treatment of scoliosis is mainly based on open surgeries that use the anterior approach, the posterior approach, or both. These surgical procedures often lead to complications including massive blood loss, infections, and pain of incision.The minimally invasive spine surgery (MISS) was introduced in the 1990s and has shown many advantages including less blood loss, less pain, and lower infection incidences.Today MISS is mainly used in the treatment of adolescent idiopathic scoliosis and adult scoliosis. However, due to some inevitable complications, it still can not be routinely applied.This review will briefly summarize the advances in the application of MISS in surgical treatment of adolescent idiopathic scoliosis and adult scoliosis.

Analysis of ribs and intraspinal anomalies in congenital scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the incidences and characteristics of the ribs and intraspinal abnormalities in surgical patients with congenital scoliosis.</p><p><b>METHODS</b>We conducted a retrospective study of the medical records and spine radiographs of 118 patients underwent surgical treatment between January 2010 and March 2011 with congenital scoliosis. The average age was 14 years (3-50 years).Fifty-two were male and 66 were female patients. The rib and intraspinal abnormalities were compared in different vertebral anomalies. Pearson's χ(2) test were used to analyze the incidence of anomalies of the ribs and vertebrae, as well as intraspinal anomalies.</p><p><b>RESULTS</b>A total of 57 (48.3%) patients were found to have intraspinal abnormalities.Split cord deformities were identified to be the most common intraspinal anomaly (32.2%), followed by syringomyelia (21.2%).Sixty-nine patients (58.5%) had rib anomalies, which occurring on the concavity of the scoliosis was most frequent. The patients with mixed deformity and failure of segment were found to have a higher incidence of rib anomaly than those with failure formation (χ(2) = 14.05, P < 0.01). The patients with multiple level malformations were found to have significantly higher incidence of rib anomaly than those with single level malformation (χ(2) = 27.50, P < 0.01).Intraspinal anomalies occurred in 42 of 69 patients (60.9%) with rib anomalies and 15 of 49 patients (30.6%) without rib anomalies in congenital scoliosis. The occurrence of intraspinal malformation has significant difference with or without rib anomalies in congenital scoliosis (χ(2) = 10.5, P < 0.01).</p><p><b>CONCLUSIONS</b>The intraspinal malformation is common in patients with mixed defects and failures of segmentation. The rib anomalies occurring on the concavity of the scoliosis is most frequent. The incidence of intraspinal anomaly is significant higher in the patients with rib anomalies than those without rib anomalies. Both the occurrence and type of rib anomaly, combined with vertebral deformity are helpful in forecasting the occurrence of intraspinal abnormalis.</p>

Analysis of clinical results and complications of growing rod technique for congenital scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate clinical outcomes of growing rod technique in treating young children with congenital scoliosis.</p><p><b>METHODS</b>From August 2002 to October 2009, 34 patients with congenital scoliosis underwent growing rod procedures including 12 male and 22 female patients. Four patients underwent posterior correction surgeries with single growing rod (single growing rod group), 30 patients underwent posterior correction surgeries with dual growing rod(dual growing rod group). The average age at initial surgery was 6.9(2-13) years. Five patients with severe rigid deformity or kyphosis had an osteotomy at apex vertebra with short segmental fusion followed by dual growing rod technique. The analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographic evaluation including scoliosis, trunk translation, length of T1-S1, thoracic kyphosis and lumbar lordosis was conducted.</p><p><b>RESULTS</b>The follow-up was 40.5 (24-110) months. In single growing rod group, the mean scoliosis Cobb angle improved from 80.9°to 59.5°after initial surgery and was 65.3°at the latest follow-up. T1-S1 length increased from average 24.3 cm to 26.0 cm after initial surgery, and to 31.1 cm at latest follow-up with an increase of 1.05 cm per year. The space available for lung ratio(SAL) in patients with thoracic curves improved from 0.81 to 0.92 at the latest follow-up. Three patients reached final fusion. Four complications occurred in 3 of the 4 patients. In dual growing rod group, the mean scoliosis Cobb angle improved from 72° ± 22°to 35 ± 14° after initial surgery and was 35 ± 17°at the last follow-up or post-final fusion. T1-S1 length increased from (25 ± 5) cm to (29 ± 5)cm after initial surgery and to (33 ± 5)cm at latest follow-up with an average T1-S1 length increase of 1.49 cm per year. The SAL in patients with thoracic curves improved from 0.84 ± 0.08 to 0.96 ± 0.06 at the latest follow-up. Three patients reached final fusion. Complications occurred in 7 of the 30 patients, and they had a total of 13 complications.</p><p><b>CONCLUSIONS</b>Growing rod technique is a safe and effective choice for young children of long, complex congenital scoliosis. It maintains correction achieved at initial surgery while allowing spinal growth to continue. Implants-related complications remain the biggest challenge.</p>

Increase of TNFα-stimulated osteoarthritic chondrocytes apoptosis and decrease of matrix metalloproteinases 9 by NF-κB inhibition / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the in vitro effect of caffeic acid phenethyl ester (CAPE), a NF-κB inhibitor, on the apoptosis of osteoarthritic (OA) chondrocytes and on the regulation of the gelatinases matrix metalloproteinase 2 (MMP-2) and matrix metalloproteinase 9 (MMP-9).</p><p><b>METHODS</b>Annexin V-FITC/propidium iodide (PI) labeling and western blotting were used to observe and determine the apoptosis in TNFα-stimulated primary cultured osteoarthritic chondrocytes. Also, gelatin zymography was applied to examine MMP-2 and MMP-9 activities in supernatants.</p><p><b>RESULTS</b>It was confirmed by both flow cytometry and western blotting that chondrocytes from OA patients have an apoptotic background. Use of CAPE in combination with 10 ng/mL of TNFα for 24 h facilitated the apoptosis. MMP-9 in the supernatant could be autoactivated (from proMMP-9 to active MMP-9), and the physiologic calcium concentration (2.5 mmol/L) could delay the autoactivation of MMP-9. The activities of MMP-2 and MMP-9 in the fresh supernatant increased significantly in response to stimulation by 10 ng/mL of TNFα for 24 h. The stimulatory effect of TNFα just on proMMP-9 was counteracted significantly by CAPE.</p><p><b>CONCLUSION</b>NF-κB could prevent chondrocytes apoptosis though its activation was attributed to the increase of proMMP-9 activity induced by TNFα (a pro-apoptotic factor). Therefore, therapeutic NF-κB inhibitor was a 'double-edged swords' to the apoptosis of chondrocytes and the secretion of MMP-9.</p>

Comparison of initial efficacy between single and dual growing rods in treatment of early onset scoliosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Initial results for the use of single and dual growing rod techniques in the treatment of early onset scoliosis (EOS) has been seldom documented. The aim of this research was to investigate the initial efficacy of single and dual growing rods in treatment of EOS.</p><p><b>METHODS</b>A retrospective study of 25 early onset scoliosis cases treated with growing rod technique between November 2002 and May 2010 was performed, including six cases in the single growing rod group and 19 cases in the dual growing rod group. Operation time, intra-operative bleeding, correction rate, changes in C7-S1 distance, and incidence of complications of the first operation were compared for the two techniques.</p><p><b>RESULTS</b>The average post-operative follow-up duration was 31.9 months. There was no statistical difference observed between operation time, intra-operative bleeding, and complication incidence between the single and dual growing rod groups. In addition, no statistical difference was observed in the pre-operative coronal Cobb's angle (P > 0.05), or in the pre-operative sagittal Cobb's angle between both groups (P > 0.05). The correction rate of the dual growing rod group was significantly superior to that of the single growing rod group in the coronal plane (P < 0.01), but not in the sagittal plane (P > 0.05). The C7-S1 distance in the dual growing rod group was significantly larger than that in the single growing rod group (P < 0.05).</p><p><b>CONCLUSIONS</b>The growing rod technique is an effective option for surgical treatment of EOS. The dual growing rod technique shows relative superiority in the correction outcome as compared to the single growing rod technique.</p>

The efficacy of one-stage posterior correction surgery for scoliotic patients with little symptomatic syringomyelia / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and effectiveness of one-stage posterior correction of scoliosis associated with little symptomatic syringomyelia.</p><p><b>METHODS</b>A total of 19 cases diagnosed as scoliosis with little symptomatic syringomyelia between January 2003 and November 2010 were included in this study (study group), the patients underwent one-stage posterior correction and instrumentation without neurosurgery for the syringomyelia. At the same time, 9 cases with severe symptomatic syringomyelia were included as the control group, the patients underwent neurosurgery before scoliosis correction, including suboccipital decompression and syrinx shunting. All patients underwent posterior pedicle screw or screw-hook hybrid instrumentation. The preoperative, postoperative and the last follow-up of the Cobb angle of the coronal main curve and thoracic kyphosis were measured. Also, the preoperative and postoperative of the apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The perioperative and the last follow-up complications of neurological injury were recorded. The surgical outcome and postoperative complications between the 2 groups were compared with the t student and chi-square statistics methods.</p><p><b>RESULTS</b>There were no significant differences in gender, age, the location, length and diameter of the syringomyelia of the 2 groups (P > 0.05). The follow-up period ranged from 6 to 45 months, with a mean of 28.6 months. The average preoperative Cobb angles of coronal main curves of the 2 groups were 71° ± 23° and 68° ± 19°, the postoperative Cobb angles were 27° ± 20° and 25° ± 16°, and the last follow-up Cobb angles were 29° ± 17° and 32° ± 20°. The coronal correction rate was 66% ± 19% in the study group and 65% ± 21% in the control group (t = 0.136, P = 0.893). There was no significant difference at the last follow-up(t = 0.210, P = 0.837). The average preoperative Cobb angles of thoracic kyphosis of the 2 groups were 35° ± 18° and 32° ± 19°, the postoperative Cobb angles were 25° ± 10° and 23° ± 9°, and the last follow-up Cobb angles were 24° ± 4° and 28° ± 8°. The mean sagittal correction rate of the 2 groups were 50% ± 58% and 57% ± 53% (t = -0.303, P = 0.764). There was also no significant difference at the last follow-up time (t = 0.769, P = 0.490). There were no significant difference, in terms of the postoperative of the apical vertebra translation, apical vertebra rotation and trunk shift between the 2 groups (P > 0.05). One case in the study group complicated with a pedicle screw breaking the anterior cortex of the vertebra and one in the control group complicated with a hook loosening, postoperatively. At the last follow-up time, the neurological symptoms of the 2 groups got no aggravating.</p><p><b>CONCLUSION</b>One-stage posterior correction of scoliosis associated with little symptomatic syringomyelia may be effective and safe.</p>

The mid-term effects of Bryan cervical disc prosthesis on sagittal alignment of overall cervical spine and the functional spinal unit / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the mid-term radiological outcome of sagittal alignment of overall cervical spine and the functional spinal unit after replacement surgery with Bryan cervical disc prosthesis.</p><p><b>METHODS</b>Eighteen patients with cervical disc disorder were performed cervical disc replacement with 20 Bryan discs from November 2005 to May 2010, including single-level 16 cases and bi-level 2 cases. The patient consisted of 13 males and 5 females with age ranging from 38 to 59 years (average, (47 ± 6) years). Fourteen cases with overall cervical lordotic alignment and segmental lordotic alignment per-operatively (group 1) and 4 others with segmental kyphotic alignment and overall cervical kyphotic alignment per-operatively (group 2). The overall sagittal alignment (C(2-7)) and segmental sagittal alignment were measured pre-operatively, post-operatively and at final follow-up to evaluate the outcome.</p><p><b>RESULTS</b>All cases obtained the follow-up with an average of (24 ± 5) months (range 12 to 53 months). To the mean overall cervical alignment, there were 9.9° ± 1.9° per-operatively, 12.8° ± 2.1° post-operatively and 11.6° ± 1.8° at final follow-up in group 1 and -1.8° ± 0.8° per-operatively, 7.3° ± 1.3° post-operatively and 5.0° ± 2.1° at final follow-up in group 2. There were statistical significance between per-operatively and post-operatively (t = -2.987 and -5.058, P < 0.05) and no statistical significance between post-operatively and final follow-up (P > 0.05) in both groups. To the mean segmental alignment there were 2.6° ± 0.8° per-operatively, 5.4° ± 1.0° post-operatively and 4.3° ± 0.9° at final follow-up in group 1 and -3.0° ± 0.8° per-operatively, 3.8° ± 1.3° post-operatively and 0.3° ± 2.8° at final follow-up in group 2. There were statistical significance between per-operatively and post-operatively in both groups (t = -3.829 and -4.086, P < 0.05) and between post-operatively and final follow-up in group 1 (t = 2.630, P < 0.05)but not in group 2 (P > 0.05).</p><p><b>CONCLUSIONS</b>The Bryan cervical disc prosthesis has a good mid-term outcome for maintaining sagittal alignment of overall cervical spine and the functional spinal unit. Long-term follow-up should be needed to assess the long-term functionality of the prosthesis.</p>

The surgery treatment of scoliosis associated with tethered cord / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and effectiveness of correction of scoliosis associated with tethered cord without releasing it.</p><p><b>METHODS</b>Twenty-two cases diagnosed as scoliosis with tethered cord between December 2005 and January 2011 were investigated retrospectively in the study. There were 8 males and 14 females. The age was from 6 to 51 years, averaged 17.7 years. There were 7 patients with clinical symptoms before surgery. All the patients underwent posterior deformity correction and instrumentation by pedicle screws directly without releasing the tethered cord. Spinal cord monitoring was conducted in all the cases. The preoperative and postoperative Cobb angle of the coronal main curve and thoracic kyphosis were measured. Also, the preoperative and postoperative values of the apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The incidence of perioperative complications were recorded.</p><p><b>RESULTS</b>A total of 20 patients were followed up. The follow-up time was from 6 to 52 months, mean 23.5 months. The average Cobb angle of the coronal main curve were 68° ± 20° before surgery and 38° ± 21° after surgery with a mean correction of 48.1%. The difference was significant (t = 13.9, P < 0.05). The mean kyphosis was 65° ± 18° preoperatively and 28° ± 11° postoperatively, with a correction of 56.7%. The difference was also significant (t = 8.81, P < 0.05). The preoperative values of the apical vertebra translation, apical vertebra rotation and trunk shift were (5.4 ± 2.5) cm, 2.3° ± 0.6° and (2.0 ± 1.8) cm, respectively, which were corrected to (3.2 ± 1.8) cm, 1.2° ± 0.5° and (1.5 ± 1.1) cm after the surgery. Compared to the preoperative values, the difference were significant in the apical vertebra translation (t = 5.69, P < 0.05) and apical vertebra rotation (t = 10.07, P < 0.05). However, there was no difference in trunk shift. Postoperative complications occurred in 3 patients, including transient numbness of the lower extremity in 1 patient and hydrothorax in 2 patients. No neurological and instrumentation complications occurred during the follow-ups. Patients with clinical symptoms before surgery got no serious during the surgery and follow-ups.</p><p><b>CONCLUSIONS</b>If there are no symptoms of tethering in scoliosis patients with tethered cord, the corrective surgeries may be safe and effective when spinal cord monitoring conducted without spinal cord untethering. But more cases are needed to confirm it.</p>

Lung function after growing rod surgery for progressive early-onset scoliosis: a preliminary study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pulmonary problems often occur in patients with early-onset scoliosis (EOS). However, lung function in patients with EOS after growing rod surgery has not been documented. The aim of this study was to investigate lung function after the treatment for EOS with growing rod and its possible correlative factors.</p><p><b>METHODS</b>Eight patients with EOS were treated with growing rod surgery at Peking Union Medical College Hospital from September 2002 to September 2009. Four patients had finished the final fusion surgery (group 1), and the other 4 (group 2) were in the process of periodic lengthening. Preoperative forced vital capacity (FVC), ratio of FVC to predicted FVC, forced expiratory volume in 1 second (FEV1), ratio of FEV1 to predicted FEV1, and radiographic measurements of Cobb's angle and C7-S1 distance were recorded. Lung function changes and correlations between lung function changes and radiographic changes (Cobb's angle and C7-S1 distance) were analyzed.</p><p><b>RESULTS</b>In group 1, FVC and FEV1 both increased. FVC showed a significant difference (P = 0.01), but FEV1 did not (P = 0.05). In group 2, FVC and FEV1 also increased, and both showed a significant difference (P = 0.04 and P = 0.02, respectively). Ratio of FVC to predicted FVC and ratio of FEV1 to predicted FEV1 changed similarly and did not show statistical differences in the 2 groups. There were no significant correlations between lung function changes and radiographic changes (Cobb's angle and C7-S1 distance) (P = 0.10 and P = 0.41, respectively).</p><p><b>CONCLUSIONS</b>Lung function increases after growing rod surgery in patients with EOS. Lung function changes do not correlate with Cobb's angle changes or C7-S1 distance changes.</p>

Adiponectin receptor 1 mediates the difference in adiponectin- induced prostaglandin E2 production in rheumatoid arthritis and osteoarthritis synovial fibroblasts / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The synovial fluid concentrations of adiponectin are significantly higher in patients with rheumatoid arthritis (RA) than in patients with osteoarthritis (OA). Accumulating evidence suggests that adiponectin may be an inducer of inflammation in arthritis, but the mechanism remains unclear. The objectives of this study were to compare the expression levels of adiponectin receptors in rheumatoid arthritis synovial fibroblasts (RASF) and osteoarthritis synovial fibroblasts (OASF), evaluate the roles of adiponectin receptors in adiponectin-induced prostaglandin E(2) (PGE(2)) production, and then investigate the effects of a nonsteroidal anti-inflammatory drug (NSAID) and a cyclooxygenase (COX)-2-selective inhibitor on adiponectin-induced PGE(2) release.</p><p><b>METHODS</b>The expressions of adiponectin receptor 1 (AdipoR1) and AdipoR2 mRNA and protein in synovial fibroblasts from seven patients with RA and eight patients with OA undergoing total knee replacement were evaluated by real-time polymerase chain reaction, immunofluorescence microscopy and Western blotting analysis. Adiponectin-induced PGE(2) production was detected by enzyme-linked immunosorbent assay. RNA interference against the AdipoR1 and AdipoR2 genes was performed to investigate the effects of the adiponectin receptors on adiponectin-induced PGE(2) production in both RASF and OASF.</p><p><b>RESULTS</b>AdipoR1 and AdipoR2 mRNA and protein were expressed by both RASF and OASF. Compared with OASF, RASF exhibited higher levels of AdipoR1, but there was no significant difference for AdipoR2. Adiponectin induced the production of PGE(2) by the synovial fibroblasts in a concentration-dependent manner, and this was more obvious in RASF. RNA interference showed that the difference may be mediated by the diverse distribution of AdipoR1. The adiponectin-induced PGE(2) production was efficiently relieved by the NSAID and COX-2-selective inhibitor.</p><p><b>CONCLUSION</b>The present findings suggest that AdipoR1 may mediate the difference in adiponectin-induced PGE(2) production in RASF and OASF.</p>

The efficacy and complications of posterior hemivertebra resection with monosegmental fusion for congenital scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and complications of posterior hemivertebra resection with monosegmental fusion in the treatment of congenital scoliosis.</p><p><b>METHODS</b>Thirty consecutive cases of congenital scoliosis managed by posterior hemivertebra resection with monosegmental fusion of the two adjacent vertebra were investigated retrospectively. Radiographs were reviewed to determine the coronal curve magnitude and sagittal alignment preoperatively, postoperatively and at last follow-up. Operative reports and patient charts were reviewed to record any perioperative and late complications.</p><p><b>RESULTS</b>The total number of resected hemivertebra was 30. Mean operation time was 193.8 min with average blood loss of 369.0 ml. The segmental scoliosis was corrected from 36.4° to 4.9° with a correction rate of 86.5%, and segmental kyphosis (difference to normal segmental alignment) from 21.2° to 6.6° with a correction rate of 68.9%. The trunk shift was improved from 17.1 to 8.8 mm. The correction of the compensatory cranial and caudal curve were 74.9% and 75.1%. There were 1 delayed wound healing, 2 pedicle cutting and 1 rod breakages. Radiolucent gaps were found on the lateral view in 2 cases without any sign of implant failure and correction loss.</p><p><b>CONCLUSIONS</b>Posterior hemivertebra resection with monosegmental fusion of the two adjacent vertebra allows for early intervention in very young children. Excellent correction in the frontal and sagittal planes can be obtained. And a short segment of fusion allows for normal growth in the unaffected parts of the spine. The most common complication is implant failure.</p>

Selective thoracic fusion in the scoliosis associated with syringomyelia / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical results of selective thoracic fusion (STF) for scoliosis associated with syringomyelia.</p><p><b>METHODS</b>From January 2001 to January 2009, 93 cases of scoliosis associated with syringomyelia were retrospectively reviewed. There were 11 cases who underwent STF and were followed up more than 2 years, which included 8 female and 3 male, the mean age was 14.9 years (9 - 21 years). Curve type, coronal and sagittal Cobb angle, apical vertebral rotation apical vertebral translation, flexibility, trunk shift were recorded and analyzed.</p><p><b>RESULTS</b>There were 9 double curves and 2 triple curves, the Lenke type of thoracolumbar/lumbar curve included Lenke A in 2 cases, Lenke B in 7 cases and Lenke C in 2 cases. The average coronal Cobb angle of thoracic curve before and after surgery were 62.6° and 19.0° respectively, and the average correction rate was 69.6%. The average coronal Cobb angle of thoracolumbar/lumbar curve before and after surgery were 36.1° and 11.6° respectively, and the average spontaneous correction rate was 67.9%. The followed up time ranged from 24 to 48 months (mean 29.5 months), the average loss of correction rate was 6.8%. Only one trunk decompensation was noted at final follow-up. Pedicle screw nut loosening occurred in one patient and this patient underwent revision surgery, no neurological complication was noted at final follow-up.</p><p><b>CONCLUSIONS</b>STF could be safely performed in scoliosis associated with syringomyelia. Thoracolumbar/lumbar curve in these patients has similar spontaneous correction ability compared with idiopathic scoliosis patients. The satisfactory result could be achieved according to the STF criteria for IS.</p>

Expression of chondromodulin-1 in the adult degenerative intervertebral disc / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the expression of chondromodulin-1 (ChM-I) in human adult degenerative intervertebral disc (IVD) cells and the relationship between ChM-I expression and disc degeneration.</p><p><b>METHODS</b>Three degenerated disc specimens obtained from patients in the treatment of disc degenerative disease from March to April 2009 were used for cell culture. ChM-I expression in IVD cells was examined by RT-PCR and Western blot. The effect of basic fibroblast growth factor (bFGF) on the expression of ChM-I was assessed by real-time PCR and Western blot. From October 2008 to October 2009, 26 human IVD tissues were obtained from patients in the surgical treatment of disc degenerative disease at different stage of degeneration according to MRI. Six IVD tissues removed from patients with metastatic spinal tumor were used as normal control. The expression of ChM-I determined by immunohistochemical analysis was correlated with MRI degeneration grade.</p><p><b>RESULTS</b>RT-PCR and Western blot examination showed that ChM-I was expressed in both adult degenerative anulus fibrosus and nucleus pulposus cells. The mRNA and protein expression of ChM-I were both down-regulated by administration of bFGF with dose-dependent way (P < 0.05). Immunohistochemical analysis showed the percent of ChM-I immunopositive cells in the control group was 0.12 ± 0.03, and the number increased significantly in the advanced degeneration group (P < 0.05).</p><p><b>CONCLUSIONS</b>The current results demonstrate that IVD cells express ChM-I. Administration of bFGF down-regulates the expression of ChM-I. The expression of ChM-I is correlated with the degree of IVD degeneration which means it may involve in the process of IVD degeneration.</p>

Primary clinical evaluation of the joint replacement for the treatment of the first metatarsophalangeal arthritis / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant.</p><p><b>METHODS</b>A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant. There were 2 males and 10 females with a mean age of 61.4 (range, 56-75) years old. Of them, 9 cases (11 feet) were hallux valgus with osteoarthritis; 1 case (2 feet) was rheumatic arthritis; 2 cases (2 feet) were traumatic arthritis. The subjective and objective results were evaluated during follow-up.</p><p><b>RESULTS</b>All of the patients were followed up regularly with an average of 24.7 months, ranging from 12 to 38 months. Ten patients were completely satisfied with the operation; 1 patient showed partial satisfaction, and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hyperosteogeny surrounding the cut bone surface 3 years after the operation. Osteolysis around the implant occurred in 2 cases without clinical symptoms, and no special treatment was given.</p><p><b>CONCLUSION</b>The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.</p>