Debridement, internal fixation, and reconstruction with titanium mesh for the surgical treatment of lumbar tuberculosis via a posterior-only approach in adults / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects, indications and key techniques of debridement, internal fixation, and reconstruction with titanium mesh in lumbar tuberculosis via a posterior-only approach in adults.</p><p><b>METHODS</b>The clinical data of 26 patients with monosegment lumbar tuberculosis treated with surgery from March 2012 to March 2014 was retrospectively analyzed. Among them, 15 cases were male and 11 cases were female, and patients' age ranged from 21 to 68 years old (average, 44.7 years old). All patients suffered from back pain and/or pain with radiation to the legs. The clinical efficacy was evaluated based on the complications, erythrocyte sedimentation rate (ESR), imaging examination, and back and leg pain score of visual analogue scale (VAS).</p><p><b>RESULTS</b>All operations were successful in 26 patients with an average operation time of (2.4±0.8) h (range from 2 to 4 h), with an average blood loss of (320±86) ml(range from 200 to 700 ml) .VAS was decreased from (5.7±1.4) points preoperatively to (1.6±0.5) points 2 weeks postoperatively (<0.01); and ESR was decreased from (42.8±10.4)mm/h preoperatively to (12.1±5.6)mm/h 3 months after surgery (<0.01). All the patients were followed up for 24 to 48 months with an average of(28.3±5.8) months. One patients suffered from the recurrence of TB and sinus tract formation at 2 months after surgery, and was cured by stronger anti-tuberculosis drugs, local debridement with drainage, and sinus tract healed at 3 months after operation. All intervertebral bone graft obtained fusion within 1 year after operation and no local recurrence of TB was found at final follow-up.</p><p><b>CONCLUSIONS</b>Debridement, internal fixation, and reconstruction with titanium mesh via a posterior-only approach is a effective and safe method for the treatment of monosegment lumbar tuberculosis, especially for the patients with secondary spinal stenosis.</p>

Morphological evidence of telocytes in mice aorta / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Telocytes (TCs) are a novel type of interstitial cells, which have been recently described in a large variety of cavitary and noncavitary organs. TCs have small cell bodies, and remarkably thin, long, and moniliform prolongations called telopodes (Tps). Until now, TCs have been found in various loose connective tissues surrounding the arterioles, venules, and capillaries, but as a histological cellular component, whether TCs exist in large arteries remains unexplored.</p><p><b>METHODS</b>TCs were identified by transmission electron microscope in the aortic arch of male C57BL/6 mice.</p><p><b>RESULTS</b>TCs in aortic arch had small cell bodies (length: 6.06-13.02 μm; width: 1.05-4.25 μm) with characteristics of specific long (7.74-39.05 μm), thin, and moniliform Tps; TCs distributed in the whole connective tissue layer of tunica adventitia: TCs in the innermost layer of tunica adventitia, located at the juncture between media and adventitia, with their long axes oriented parallel to the outer elastic membrane; and TCs in outer layers of tunica adventitia, were embedded among transverse and longitudinal oriented collagen fibers, forming a highly complex three-dimensional meshwork. Moreover, desmosomes were observed, serving as pathways connecting neighboring Tps. In addition, vesicles shed from the surface of TCs into the extracellular matrix, participating in some biological processes.</p><p><b>CONCLUSIONS</b>TCs in aorta arch are a newly recognized complement distinct from other interstitial cells in large arteries, such as fibroblasts. And further biologically functional correlations need to be elucidated.</p>

Comparative Analysis of Telomerase Activity in CD117⁺ CD34⁺ Cardiac Telocytes with Bone Mesenchymal Stem Cells, Cardiac Fibroblasts and Cardiomyocytes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study characterized the cardiac telocyte (TC) population both in vivo and in vitro, and investigated its telomerase activity related to mitosis.</p><p><b>METHODS</b>Using transmission electron microscopy and a phase contrast microscope, the typical morphological features of cardiac TCs were observed; by targeting the cell surface proteins CD117 and CD34, CD117 + CD34 + cardiac TCs were sorted via flow cytometry and validated by immunofluorescence based on the primary cell culture. Then the optimized basal nutrient medium for selected population was examined with the cell counting kit 8. Under this conditioned medium, the process of cell division was captured, and the telomerase activity of CD117 + CD34 + cardiac TCs was detected in comparison with bone mesenchymal stem cells (BMSCs), cardiac fibroblasts (CFBs), cardiomyocytes (CMs).</p><p><b>RESULTS</b>Cardiac TCs projected characteristic telopodes with thin segments (podomers) in alternation with dilation (podoms). In addition, 64% of the primary cultured cardiac TCs were composed of CD117 + CD34 + cardiac TCs; which was verified by immunofluorescence. In a live cell imaging system, CD117 + CD34 + cardiac TCs were observed to enter into cell division in a short time, followed by an significant invagination forming across the middle of the cell body. Using a real-time quantitative telomeric-repeat amplification assay, the telomerase concentration in CD117 + CD34 + cardiac TCs was obviously lower than in BMSCs and CFBs, and significantly higher than in CMs.</p><p><b>CONCLUSIONS</b>Cardiac TCs represent a unique cell population and CD117 + CD34 + cardiac TCs have relative low telomerase activity that differs from BMSCs, CFBs and CMs and thus they might play an important role in maintaining cardiac homeostasis.</p>

Feasibility and efficiency of embolization of spinal dural arteriovenous fistula / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficiency of embolization of spinal dural arteriovenous fistula (SDAVF).</p><p><b>METHODS</b>From December 2010 to May 2012, there were 104 cases of SDAVF were treated, and 26 cases were selected to be treated with embolization. The inclusion criteria was as follows: (1) No anterior or posterior spinal artery originated from the fistula segment; (2) The segmental artery can be catheterized with guiding or micro catheter; (3) High flow in fistula; (4) Patient's situation was not suitable for surgery or general anesthesia. Among 26 cases, there were 22 male and 4 female patients, the average age was 55.9 years (ranged from 34 to 81 years). The locations of SDAVF were 10 cases in thoracic, 9 in lumbar and 7 in sacral segment. The main symptoms were progressive numbness and weakness in both lower extremities, most cases accompanied with difficulties in urination and defecation. The average history was 17.1 months (from 1 to 156 months). ONYX-18 liquid embolic agent or Glubran-2 surgical glue were used as embolic material. The patients not cured with embolization were treated with surgery in the following 1 - 2 weeks. Follow-up evaluation was done with MRI after 3 months and DSA after 6 months, besides physical examination.</p><p><b>RESULTS</b>Fifteen from 26 cases achieved immediate angiographic cure results: 14 in 20 cases which embolized with ONYX-18; only 1 in 6 cases with Glubran-2. Three in 10 cases of thoracic SDAVF and 12 in 16 cases of lumbar/sacral SDAVF were cured with embolization. Partially embolized cases were treated with surgical obliteration of drainage veins within 2 weeks. Cured patients experienced immediate improvement after embolization and kept getting better in the follow-up. All the patients had MRI follow-up after 3 months and DSA follow-up after 6 months. In 6 month's follow-up, MRI showed the edema and flow void signal in the spinal cord disappeared. DSA showed no fistula recurrence or remnant. There was no deterioration case in all of the embolized cases.</p><p><b>CONCLUSIONS</b>Particular SDAVF is suitable for embolization with ONYX-18. Most lesions located in lumbar and sacral segment are good indications for embolization.</p>

Strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction for the treatment of severe adolescent idiopathic scoliosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many investigators advocate anterior release combined with halo-femoral traction and posterior fusion when treating stiff thoracic curves in patient with adolescent idiopathic scoliosis (AIS). But the anterior operations often induce severe complications. Some surgeons choose posterior-only surgery with halo-femoral traction, posterior wide release and correction. But to the best of our knowledge, there are only rare prospective studies on these posterior-only surgeries for AIS patients who have a rigid curve more than 80° and flexibility less than 35%.</p><p><b>METHODS</b>Sixty-four AIS patients were recruited from September 2006 to June 2009. All patients had rigid curves and underwent spinal correction. They were randomly divided into group A (combined anteroposterior surgery) and group B (posterior-only surgery). Images and scoliosis research society-22 questionnaire (SRS-22) scores were performed pre- and post-operation and during follow-up visits. The operation time, blood loss, hospital days, and hospital charges were compared between the two groups.</p><p><b>RESULTS</b>These patients were followed for an average of 37.5 months (range, 24 - 65 months). No serious complications were observed. There were no significant differences between the two groups in gender, age, preoperative radiographic data, or preoperative SRS-22 score. The average operation time, blood loss, hospital days and hospital charges in group B were less than those in group A. The SRS-22 score in group B was better than in group A at post-operation and at final follow-up.</p><p><b>CONCLUSIONS</b>In AIS with a rigid curve more than 80° and flexibility less than 35%, strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction can provide better SRS-22 scores, comparable curve correction, shorter operation time, less blood loss, shorter hospital stays and lower charges when compared to combined anterior and posterior surgery.</p>

Protective effect of tongxinluo superfines on angiotensin II caused renal injury in rat / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the renal protective effect of Tongxinluo (TXL) and its mechanism of action.</p><p><b>METHODS</b>Eight-week old SD rats were divided into the sham-operated group (A), the model group (B) and the TXL group, 6 rats in each group. Angiotensin II (Ang II) was administered slowly (200 ng/kg per min) to rats in group B and C via subcutaneously embedded osmotic pump to make them stimulative model of renal injury, while to rats in group A, pump embedding with saline infusion. After modeling, TXL was given to group C by gastric perfusion in dosage of 0.8 g/kg per day. And the following indexes were observed 14 days later: configuration of renal arterial endothelium by transmission electron microscope; pathologic figure of kidney with HE stain; renal apoptosis by TUNEL; expression of p53 and p22phox by RT-PCR;and level of reactive oxygen species (ROS) in kidney.</p><p><b>RESULTS</b>Different degree of congestion, swelling, denudation of endothelial cell in renal arterial endothelial cell; glomerular matrix proliferation and partial glomerular atrophy with tendency of fibrosis; increased renal parenchymal apoptosis; enhanced expression of p53 and p22phox; and elevated ROS were found in model animals. All the above-mentioned abnormalities, including glomerular injury, renal cell apoptosis, as well as the increased p53, p22phox expressions and ROS production were all alleviated in group C after TXL treatment.</p><p><b>CONCLUSION</b>TXL could protect renal against Ang II injury, and it may be realized by inhibiting NADPH-ROS/p53 pathways and suppressing cell apoptosis in renal parenchyma.</p>

A controlled clinical trail of perioperative nutritional support of thoracolumbar spinal tuberculosis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the influence of perioperative nutritional support on nutritional status of patients with thoracolumbar spinal tuberculosis.</p><p><b>METHODS</b>Forty-eight patients with thoracolumbar spinal tuberculosis (male 25 and female 23, aged from 35 to 60 years, with an average of 48.25 years) were randomized into two groups. Twenty-four patients nutritional support were increased intravenously for 14 days (7 days before and after operation) in experimental group. Twenty-four patients in control group were supplied with routine diet. The body weight, plasma concentrations of albumin and ESR were detected on the 7th day before operation and on the 7th day after operation. The total wound drainage was recorded and compared.</p><p><b>RESULTS</b>Body weight and plasma concentrations of albumin on the 7th day after operation and those on the 7th day before operation were not significantly different in experimental group (P > 0.05). In control group, body weight and plasma concentrations of albumin on the 7th day after operation was lower than those on the 7th day before operation (P < 0.05). The total wound drainage of experimental group was less than that of control group (P < 0.05). ESR on the 7th day after operation was lower than that on the 7th day before operation in two groups (P < 0.05); but the decrease of ESR in experimental group was more than that in control group (P < 0.05).</p><p><b>CONCLUSION</b>Nutritional support is beneficial to alleviating innutrition caused by tubercle bacillus and operation. It can promote the effects of operation and anti-tuberculotic drugs.</p>

Infection of intervertebral space and the interventional therapy / 中南大学学报(医学版)

OBJECTIVE@#To investigate the effect of interventional therapy in the treatment of intervertebral space infection.@*METHODS@#The needle was punctured into the infected intervertebral space from the post-lateral side of the spine monitored by X-rays. The pus was drained, the degenerative disc tissues and necrosis tissues were excised and taken out, and at the end a drainaging catheter was put into the space through the needle. The patient should lie in bed absolutely. The antibiotics was injected into the space through the silicon catheter every day. Three to four weeks later, the catheter was removed.@*RESULTS@#All the 8 patients got good results after the therapy. The low back pain was dramatically alleviated instantly at the day of operation. Erythrocyte sedimental rate gradually descended. After 3 approximately 4 weeks of treatment,the catheter was removed.@*CONCLUSION@#Interventional therapy of the intervertebral space infection has notable advantage over the open operation.

Surgical treatment for lumbar discogenic low back pain / 中南大学学报(医学版)

OBJECTIVE@#To explore the curative effect of surgical treatment for lumbar discogenic low back pain.@*METHODS@#Forty-two patients with lumbar discogenic low back pain were treated with disc excision and lumbar interbody fusion: 12 of them were treated with posterior lumbar interbody fusion (PLIF), 30 with afront lumbar interbody fusion (ALIF). The clinical results were evaluated by pre- and post-operative visual analogue scale (VAS), and the fusion rates of the lumbosacral spine were evaluated by X-ray.@*RESULTS@#The average follow-up period was 18 months, ranging from 6 to 36 months. Low back pain basically disappeared in 11 patients treated with PLIF, with mild back pain in one patient; VAS after the operation decreased significantly in comparison with that preoperatively (P<0.01). Low back pain basically disappeared in 28 patients treated with ALIF; VAS after the operation decreased significantly in comparison with that preoperatively (P<0.01). The fusion rate was 90% in patients treated with PLIF, and 93% in patients with ALIF.@*CONCLUSION@#Disc excision and interbody fusion is effective in the treatment of lumbar discogenic low back pain, but the operation indications should be paid attention to.

Treatment of intracranial arterial lesions with covered stents / 中国脑血管病杂志

Objective: We present our preliminary experience on the treatment of intracranial arterial lesions with covered stent in a series of patients. Methods: 20 patients have been treated by using Jostent coronary covered stent deployed in the parent artery across the lesions, which included aneurysms, iatrogenic or traumatic arterial injury, and traumatic carotid-cavernous fistula (TCCF). The profile of stent was determinded with the diameter of parent artery and the length of lesion. 5 cases of intradural vertebral aneurysms, 7 internal carotid artery (ICA) aneurysms (1 petrous, 2 cavernous, 2 ophthalmic, 2 supracliniodal segment), 1 iatrogenic ICA injury, 3 traumatic ICA aneurysms, 3 traumatic carotid cavernous fistula and 1 ICA cavernous segment stenosis with spontanous CCF were treated. 21 Jostent covered stent had been used. Combination of bare stent and covered stent were used in 3 cases. Results: Technical success were achieved in 17 cases. Each case had one lesion. Lesions were excluded from circulation in 14 cases. There were 3 cases with lesion reminants or endoleakage just after treatment, but disappeared soon in the follow-up angiography. No complication was found in successful cases. Covered stent deployment were failed in 3 cases. One had transient slight paraplegia. There was no severe complication or death. Conclusion: Excluding the lesion from circulation with covered stent has been proved to be an effective reconstructive treatment of intracranial arterial lesions. Further research and development are needed to make the indication even broader.

Different methods of intracranial-extracranial bypass surgery for the treatment of intracranial aneurysms / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects and methods of intracranial-extracranial (IC-EC) bypass surgery in the treatment of intracranial aneurysms.</p><p><b>METHODS</b>The clinical material of 9 cases, who performed IC-EC bypass surgery before occlusion of the parental arteries of intracranial aneurysms, was studied retrospectively, especially how to evaluate the co-lateral circulation of the parental arteries and how to select the different methods of IC-EC bypass surgery.</p><p><b>RESULTS</b>The co-lateral circulation in 9 cases was not enough to meet the need of the cerebral blood flow after occlusion of the parental arteries of the aneurysms. Revascularization by different methods of IC-EC bypass surgery and then occlusion of the parental arteries, ischemia in the brain area feeding by occluded parental arteries of the aneurysms did not occurred.</p><p><b>CONCLUSION</b>When the co-lateral circulation of the parental arteries of intracranial aneurysm is not enough, the revascularization by different methods of IC-EC bypass surgery is needed before occlusion of these arteries.</p>

Diagnosis and treatment of spinal dural arteriovenous fistulas: 110 cases report / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis, treatment and prognosis of spinal dural arteriovenous fistulas (SDAVF).</p><p><b>METHODS</b>The clinical and following-up date from 110 patients with SDAVF diagnosed by spinal MRI and spinal angiography were analyzed retrospectively.</p><p><b>RESULTS</b>Draining vein between fistula and spinal cord was interrupted by laminectomy approach as first choice in 61 patients, by hemi-laminectomy approach in 37, and by endovascular embolization in 12, and re-operation due to recurrence after embolization in 3. Anticoagulation, hydration and early rehabilitation were used postoperatively. Complete disappearance of SDAVF was confirmed in all 106 patients who received postoperative spinal angiography. The para-medullary tortuous flow voids fully disappeared in 74 patients and partly disappeared in 15 on postoperative T(2)-weighted MRI. Follow up of 98 patients showed complete recovery in 54 patients, improvement in 34, and no change in 10. Three of the 10 patients were reoperated on because of recurrence 1 to 5 years after embolization.</p><p><b>CONCLUSIONS</b>SDAVF can produce good outcome after early diagnosis and treatment. Interruption of the draining vein between fistula and spinal cord by hemi-laminectomy approach is the first choice for the treatment of SDAVF.</p>