Status and progress of school screening for adolescent scoliosis / 中华骨科杂志

Scoliosis is one of the common diseases in adolescents. It can rapidly progress during the peak growth period. Scoliosis school screening (SSS) is the main way for early detection and treatment of this disease. The SSS project began in the 1960s and was gradually promoted from the United States to the world. However, some problems were gradually exposed during the implementation of the project, such as the high false positive rate of screening methods, potential radiation damage, the uncertainty of the potency ratio of screening and the lack of evidence-based medical evidence of the effectiveness of high-level conservative treatment, which led to many European and American countries stopping the implementation of SSS. However, with the progress of research related to diagnosis and treatment of scoliosis, based on the latest evidence-based medical evidence assessment, the United States Preventive Medicine Task Force again adjusted the recommendation level of SSS to "no recommendation, no objection" in 2018. In recent years, SSS has gradually received extensive attention from the Chinese government and society. Five national ministries and commissions also issued a document in 2021 to include scoliosis in the monitoring of common diseases among students. However, the implementation of the project should also refer to the effectiveness criteria of disease screening recommended by the World Health Organization. In the future, with the improvement of the accuracy of scoliosis screening methods, the development of multi-mode screening such as artificial intelligence, the emergence of non-radiation detection technology and the improvement of the effectiveness of conservative treatment of mild and moderate scoliosis, the long-term and large-scale implementation of SSS project and the early prevention and control of scoliosis will be possible to truly achieve.

Pedicled bridge transplantation for soft tissue defects at the contrallateral leg with medial leg skin flap and medial hemi-soleus muscle flap / 中华创伤骨科杂志

Objective:To evaluate the pedicled bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap for the treatment of soft tissue defects at the contrallateral leg.Methods:Between January of 2012 and January of 2016, 8 patients with soft tissue defects at the leg were treated at Department of Orthopedic Surgery, Hand and Foot Surgery Hospital of Lanzhou. They were 5 men and 3 women, aged from 19 to 50 years (mean, 35 years). All of them were treated by bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap pedicled with posterior tibial artery. The size of the defects ranged from 10 cm×9 cm to 13 cm×8 cm. The immediate coverage of the muscle flaps and vessel pedicle was repaired by a meshed split-thickness skin graft. The donor site was closed directly. The therapeutic efficacy was assessed at the final follow-up according to the criteria by Iowa for tibial fractures.Results:All the skin flaps and muscle flaps survived without any vascular crisis. One case developed necrosis of small skin graft at the distal muscle flap which spontaneously healed after dressing change for 2 weeks. Their follow-up ranged from 2.5 to 4.5 years (mean, 3.8 years). A good contour was confirmed at the recipient area. By the Iowa criteria at the final follow-up, 3 cases were excellent, 4 good and one fair.Conclusion:Pedicled bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap is a good treatment for soft tissue defects at the contrallateral leg which has only one major blood vessel, reducing damage to the donor site.

AATYK is a Novel Regulator of Oligodendrocyte Differentiation and Myelination / 神经科学通报·英文版

Oligodendrocytes (OLs) are myelinating glial cells that form myelin sheaths around axons to ensure rapid and focal conduction of action potentials. Here, we found that an axonal outgrowth regulatory molecule, AATYK (apoptosis-associated tyrosine kinase), was up-regulated with OL differentiation and remyelination. We therefore studied its role in OL differentiation. The results showed that AATYK knockdown inhibited OL differentiation and the expression of myelin genes in vitro. Moreover, AATYK-deficiency maintained the proliferation status of OLs but did not affect their survival. Thus, AATYK is essential for the differentiation of OLs.

Application of descending neurogenic evoked potentials monitoring during spinal deformity surgery / 中华骨科杂志

Objective To elevate the efficacy and safety of descending neurogenic evoked potentials (DNEP) monitoring during severe rigid spinal deformity surgery.Methods All of 108 patients (43 males,65 females) who underwent surgical treatment for spinal deformity in our spinal center from July 2010 to August 2013 were retrospectively reviewed.The average age (17.5±5.8) ys(range 12-50 ys),the average following period is 38.6 months(range 24-52 months).Combined monitoring of SEP,MEP and DNEP model were used during surgery.All subjects with no neurological deficits preoperatively and got satisfied outcomes.Respectively evaluate the results of neurophysiological intraoperative monitoring (IOM).Data were collected to elevate the efficacy and safety of DNEP monitoring.Results All of 108 patients,15 patients (13.9％,15/108) showed significant changes of neurophysiological parameters,of which 9 cases (60％,9/15) were identified as true positive and 6 cases (40％,6/15) were identified as false positive.During the following-up period,2 patients developed permanent neurological deficit,and 3 patients showed transient neurological deficit who got fully recovered within 6 months after operation.DNEP showed alert in all 5 patients with truepositive alarm,of which 2 patients developed permanent neurological dysfunction and 3 cases showed postoperative short nerve dysfunction that got fully recovery within 6 months after operation.The sensitivity and specificity of SEP+MEP and DNEP were 100％ and 97.98％,100％ and 98.99％,respectively.Conclusion Combining use of MEP+SEP+DNEP monitoring during surgical treatment of spinal deformities presented to be a highly reliable method for the detection and prevention of iatrogenic injury.The results confirmed a high efficacy and safety of DNEP monitoring during spinal surgery.

Perioperative respiratory care in severe scoliosis patients / 现代临床护理

Objective To investigate perioperative nursing of respiratory system in severe scoliosis patients.Methods 26 severe scoliosis patients with respiratory function training before operation were retrospected.All of them tested pulmonary function before and after training,postoperative respiratory system nursing were also taken to maintain airway unobstructed,including respiratory rate and oxygen saturation monitoring,effective pain management and respiratory complications controlling.Results The average forced vital capacity(FVC)was 45.9%and 52.1%before and after breathing exercises,the mean forced expiratory volume in one second(FEV1)was 43.8%and 48.8%before and after breathing exercises,with lung function improvement in 69.2%patients. There were two hemopneumothorax and three mild or moderate pleural effusion occurred within 10 days after surgery,but all recovered after effective treatment and nursing.Conclusions Perioperative systematic and effective training in respiratory function and airway management can improve lung function and surgical safety,reduce the incidence of postoperative pulmonary complications,and promote early rehabilitation .

Quality of life for Chinese patients with adolescent idiopathic scoliosis: evaluation of the Chinese version of the Scoliosis Research Society's outcomes instrument 22 / 中华物理医学与康复杂志

Objective To evaluate the health-related quality of life ( HRQL) of patients with adolescent idiopathic scoliosis ( AIS) before treatment. Methods Sixty-two female patients with AIS were evaluated using the Chinese version of Scoliosis Research Society's outcomes instrument 22 ( SRS-22) HRQL questionnaire before treatment. The patients were categorized into thFee groups: a mild deformity group with a major curve Cobb angle less than 30° ( n =14),a moderate deformity group with Cobb angles of 30° to 50° ( n =42), and a severe deformity group with Cobb angles more than 50° ( n =6). Results The severe deformity group scored lowest in the self-image domain.There was,however,no significant difference in the functional activity,pain or mental health domain scores between the three groups. Conclusions The Chinese version of the SRS-22 HRQL questionnaire can be used to assess the HRQL of Chinese AIS patients.AIS patients with a major curve Cobb angle more than 50° have relatively low self-image scores.

Efficacy of combined monitoring with TES-MEP and CSEP during anterior or posterior surgery for cervical spondylitic myelopathy / 中华创伤杂志

Objective To evaluate of the efficacy of transcranial electrical stimulation motor evoked potential (TES-MEP)in combination with cortical somatosensory evoked potential (CSEP) monitoring during the anterior or posterior approach spinal surgery for cervical spondylitie myelopathy (CSM).Methods TES-MEP on the bilateral anterior tibial muscle and flexor hallucal brevis and thenar muscles and CSEP on the bilateral posterior tibial nerve and ulnar nerve were observed simultaneously in 135 patients during spinal surgery.Intravenous anesthesia was employed in all the patients.The results of TES-MEP,CSEP and combined monitoring were analyzed statistically.Pre-oporative and post-operative motor and sensory functions of the spinal cord were compared. Result Success rate of TES-MEP,CSEP and the combined monitoring was 87.4%.97.8%and 100%,respectively.Out of 135 patients,nine patients (6.7%) were detected with the positive evoked potentials due to surgical operation.The sensitivity of TES-MEP and CSEP in assessing the spinal cord motor function was 100%and 83.3%,respectively,while that in assessing the spinal cord sensory function was 77.8%and 100%,respectively.The sensitivity and specificity of the combined monitoring was both 100%. Conclusion The successful detection rate and accuracy of the combined monitoring for spinal cord function are apparently higher than that of simple TES-MEP or CSEP.The causes for operative maneuvers evoking a positive evoked potential include complete anterior decompression of the spinal canal,intervertebral bone graft,laminoplasty for OPLL and hematoma compression caused by a failed drainage in a posterior-anterior approach surgery.

In vitro Efficacy of mda-7 Gene for Hepatocellular Carcinoma Gene Therapy Mediated by Human Ribosomal DNA Targeting Vector / 生物化学与生物物理进展

Human ribosomal DNA (hrDNA) targeting vector pHr is a homologous recombinant plasmid for human genome which developed in the State Key Laboratory of Medical Genetics. pHr was used to construct a recombinant plasmid pHr-CMG expressing mda-7/GFP fusion gene and its efficacy in the hepatocellular carcinoma cell line Bel-7402 was investigated. The expression of mda-7/GFP fusion gene was detected by fluorescent microscope, RT-PCR and Western blotting, and its function was detected by cell-cycle analyses, MTT assay and Hoechst33258 staining. The results demonstrated that pHr-CMG vector could express MDA-7/GFP fusion protein effectually and the mda-7 gene could induce cell apoptosis and proliferation suppression in Bel-7402 cell line, which might be caused by the G2/M cell cycle arrest. These results also suggested that human ribosomal DNA targeting vector system and the pHr-CMG vector may be applied in further gene therapy researches for hepatocellular carcinoma.

The application of allograft fusion cage for cervical spinal anterior interbody fusion / 中华骨科杂志

Objective To evaluate the effects of allograft fusion cage(AFC) on anterior cervical interbody fusion. Methods AFCs were implanted in 61 degenerative cervical intervertebral spaces of 39 cases, who needed anterior cervical interbody fusion from September 1995 to December 1999. 31 cases were diagnosed as cervical spondylolysis， 2 cases as acute protrusion of cervical intervertebral disc and 6 cases as fracture and dislocation of cervical spine. The clinical effects and complications were observed, and the postoperative presentations of X－ ray examination of cervical spine were also evaluated. Results Thirty- nine cases were followed up with a mean period of 28.6 months. No neurologic complications appeared, and no AFCs shifted or dislocated. The clinical effects were satisfactory. 61 intervertebral spaces were confirmed to be solid fused completely by constant X－ ray examination at 3.9 months in average after operation. There were no collapse or angular deformities in 59 spaces of them,the other 2 spaces lost a little height because of removal of external fixation too early. Conclusion The implantation of AFC was simple, stable, less injury with similar intervertebral osseous fusion rate compared to the conventional anterior cervical interbody fusion. Forthermore, the implantation of AFC does not need auto iliac crest graft or the use of metal fixations. Some complications caused by implanting auto iliac crest and metal fixations can be avoided.

Biomechanical Evaluation on Cervical spine stabilizing Effects of Cervical Interbody Spinal Fusion Using Allograft Fusion Cage / 中华骨科杂志

Objective\ To evaluate the immediate effects and strength of allograft fusion cage(AFC) used for reconstructing stability of cervical spine. Methods\ Discs of C 5 and C 6 were resected on 8 fresh human cervical spine specimens, and autogenous iliac bone grafts(AIBG), and AFCs were implanted into the intervertebral spaces respectively. Compression test, pull out test and segmental motion measurement were studied.Results\ Comparing with intact and AIBG groups, the range of motions of C5-6 in AFC group were decreased in all directions except for extension; with (502?114) N compressive load,the vertebrae in AFC group were broken while the AFC were intact, but the AIBG were broken at (135?42) N load; with 300 N drawing load,no loosening was found between AFCs and vertebra, but it was found between AIBG and vertebra at 60 N load. Conclusion\ AFC could provide enough support,anti slide ability and could remain or increase the height of intervertebral spaces. It completely meets clinical and biomechanical requirements.