The effect of mild hypothermia plus rutin on the treatment of spinal cord injury and inflammatory factors by repressing TGF-β/smad pathway

ABSTRACT Purpose To probe the mechanism of mild hypothermia combined with rutin in the treatment of spinal cord injury (SCI). Methods Thirty rats were randomized into the following groups: control, sham, model, mild hypothermia (MH), and mild hypothermia plus rutin (MH+Rutin). We used modified Allen's method to injure the spinal cord (T10) in rats, and then treated it with MH or/and rutin immediately. BBB scores were performed on all rats. We used HE staining for observing the injured spinal cord tissue; ELISA for assaying TNF-α, IL-1β, IL-8, Myeloperoxidase (MPO), and Malondialdehyde (MDA) contents; Dihydroethidium (DHE) for measuring the reactive oxygen species (ROS) content; flow cytometry for detecting apoptosis; and both RT-qPCR and Western blot for determining the expression levels of TGF-β/Smad pathway related proteins (TGF-β, Smad2, and Smad3). Results In comparison with model group, the BBB score of MH increased to a certain extent and MH+Rutin group increased more than MH group (p < 0.05). After treatment with MH and MH+Rutin, the inflammatory infiltration diminished. MH and MH+Rutin tellingly dwindled TNF-β, MDA and ROS contents (p < 0.01), and minified spinal cord cell apoptosis. MH and MH+Rutin could patently diminished TGF-β1, Smad2, and Smad3 expression (p < 0.01). Conclusions MH+Rutin can suppress the activation of TGF-β/Smad pathway, hence repressing the cellular inflammatory response after SCI.

Clinical application of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template

OBJECTIVES: To investigate the primary clinical value of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. METHODS: We retrospectively analyzed the cases of 17 patients treated from June 2015 to September 2016 with atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. All procedures were performed prior to surgery, including thin-slice CT scanning, medical image sampling and computerized 3D modeling of the atlantoaxial joint, optimal pedicle screw trajectory determination, and anatomical trait acquisition for the atlantoaxial pedicle, spinous process of the axis, vertebral lamina and posterior lateral mass, and design of a reverse template. During surgery, a navigation template was tightly attached to the atlantoaxial joint to assist in pedicle screw placement. Surgeons subsequently used an electric drill to remove the template through a guide channel and then placed the atlantoaxial pedicle screw. Observed indexes included the VAS score, JOA improvement rate, surgery duration, and blood loss. RESULTS: Surgery was successful in all 17 patients, with an average operation duration of 106±25 min and an average blood loss of 220±125 ml. Three days postoperatively, the VAS score decreased from 6.42±2.21 to 3.15±1.26. Six months postoperatively, the score decreased to 2.05±1.56. The postoperative JOA score increased significantly from 7.68±2.51 to 11.65±2.72 3 d after surgery and to 13.65±2.57 after 6 months. Sixty-eight pedicle screws were inserted successfully, with 34 in the atlas and 34 in the axis. According to the Kawaguchi standard, 66 screws were in grade 0 (97.06%), and 2 were in grade 1 (2.94%). The pre- and postoperative transverse and sagittal screw angles showed no significant differences. CONCLUSIONS: Atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template is worth recommending due to the improved accuracy in screw placement, improved patient safety and beneficial clinical effects.