Exploring the ability of TAT, a cell-penetrating peptide, to deliver proteins in a non-fused form / 药学学报

Accumulating evidence has shown that the cell-penetrating peptide TAT can be applied to deliver different types of drug molecules, including nucleic acids, proteins and small molecule drugs. Usually TAT delivers cargoes on the basis of their covalent bonds or non-covalent interactions. However, there are few reports on the delivery of proteins by TAT in a non-covalent manner, and no quantitative comparisons have been made on the protein delivery ability of TAT in fusion and non-fusion manners. In order to explore the ability of TAT to deliver proteins in non-fusion manner, here we used fluorescence microscopy and flow cytometry to investigate the ability of TAT to deliver enhanced green fluorescent protein (EGFP) into non-small cell lung cancer cells A549 in a non-fusion manner. It was found that TAT could deliver EGFP into A549 cells, and its delivery ability was positively correlated with its concentration. In addition, the fusion protein TAT-EGFP was overexpressed and purified, and its permeability across cell membrane was also investigated. In this paper, based on quantitative comparison, we found that the delivery of EGFP by TAT in fusion manner is significantly efficient than that of TAT in non-fusion manner. This is the report that TAT can deliver EGFP in a non-fusion manner. Although its delivery efficiency remains to be improved as compared with the fusion manner, the non-fusion manner has shown incomparable advantages in ease of operation, suggesting that it is also a candidate for delivery strategy in the future.

Research progress of Wallis dynamic stabilization system for lumbar degenerative diseases / 中国骨伤

Wallis dynamic stabilization system is a surgical approach in the non-fusion technique of lumbar spine, consisting of interspinous blockers and dacron artificial ligaments that provide stability to the spine while maintaining a degree of motion in the affected segment. Recent studies have demonstrated the significant benefits of Wallis dynamic stabilization system in treating lumbar degenerative diseases. It not only improves clinical symptoms, but also effectively delays complications such as adjacent segmental degeneration. This paper aims to review the literature related to the Wallis dynamic stabilization system and degenerative diseases of the lumbar spine to describe the long-term prognostic effect of this system in the treatment of such diseases. This review provides a theoretical basis and reference for selecting surgical methods to treat degenerative diseases of the lumbar spine.

Research and application of artificial cervical disc / 中国组织工程研究

BACKGROUND: For patients with cervical spondylosis who fail to receive conservative treatment, cervical anterior decompression and fusion has always been the gold standard for surgical treatment. Since its use, it has been widely recognized by clinicians for its simple and convenient intraoperative operation and significant relief of pathological segmental symptoms after surgery. As time goes by, the problem of degeneration of surgery adjacent segments and loss of mobility of the replacement segments is gradually exposed. At the same time, the patient's requirements for postoperative rehabilitation and quality of life are constantly improving, and surgical technology continues to develop rapidly. This type of surgery cannot meet the clinical needs. Therefore, total cervical disc replacement surgery comes into being, which can solve the related problems caused by anterior cervical decompression and fusion, and the clinical effect is better than previous one. OBJECTIVE: To review the research status of artificial cervical intervertebral discs, to focus on its clinical effects and structure, and to prospect its improvement and development direction of artificial development direction. METHODS: A compute-based retrieval of CNKI, WanFang and PubMed databases was conducted for articles published between January 1995 and August 2019. The keywords were "non-fusion technique, artificial intervertebral disc, clinical efficacy, structure" in Chinese and English, respectively. The articles related to artificial cervical intervertebral disc were selected, and the latest experimental and clinical researches were preferred. RESULTS AND CONCLUSION: (1) Through analyzing the main artificial cervical discs on the market, the research of artificial cervical discs will focus on materials, structures, implantation devices and surgical approaches of prosthesis. The domestic cervical disc will be designed based on the anatomical features of the Chinese cervical spine. (2) It is believed that the future cervical disc replacement surgery will achieve a satisfactory clinical effect, and its postoperative complications will be significantly reduced, which can meet the requirements of Chinese people.

Injury to upper cervical spine treated by posterior internal fixation without bone graft fusion / 中华创伤骨科杂志

Objective To investigate the clinical efficacy of treating injury to the upper cervical spine with posterior internal fixation without bone graft fusion.Methods Included in this retrospective study were 35 patients with upper cervical injury who had been treated at Department of Orthopedics,The Second Affiliated Hospital to Soochow University from June 2010 to August 2017.They were 21 males and 14 females with an average age of 44.1 years (from 26 to 56 years).They were all treated firstly by posterior occipitocervical internal fixation or internal fixation with atlantoaxial pedicle screws without bone graft fusion.The internal fixation was then removed after a solid bone union was confirmed by X-ray.The scores of Japanese Orthopedic Association (JOA),visual analogue scale (VAS),Neck disability index (NDI) and neck stiffness were used to evaluate the functional recovery of the upper cervical spine.We also observed the rotational range of the upper cervical spine using functional CT scan of C 1-C2.Results All the pedicle screws were successfully implanted after satisfactory intraoperative reduction,leading to no injury to the vertebral artery or spinal cord.All patients were followed up for an average of 18.1 months (from 7 to 28 months).At preoperation,post-implantation and final follow-up,the JOA scores were 6.5 ± 1.4,7.7 ± 1.5 and 16.1 ± 0.8 points,the VAS scores 6.1 ± 1.6,2.8 ± 0.8 and 1.1 ± 0.9 points,and the NDI scores 37.9 ± 2.6,20.3 ± 3.8 and 3.7 ± 1.7 points,showing significant improvements after internal fixation and after removal of internal fixation (P ＜ 0.05).Serious neck stiffness was observed in none of the 35 patients,mild neck stiffness in 12 patients and freedom from neck stiffness in 23 patients.The postoperative radiological analysis revealed fine fracture reduction and bony union in all.After 6 to 12 months the rotation of upper cervical spine was obviously improved and the left-to-right range of rotation of C 1-C2 was 35.4° ± 2.6° as revealed by functional CT scan.Conclusion For the middle aged and young patients with new injury to the upper cervical spine,the posterior occipitocervical internal fixation or internal fixation with atlantoaxial pedicle screws can be performed without bone graft fusion at the first stage and removal of internal fixation can be done at the second stage so that the atlantoaxial rotation can be preserved to ensure satisfactory clinical efficacy while bone union can be also ensured and pain reduced.

Analysis Of The Fusion Of Hyoid Bone In Different Age-groups

Background: The greater cornua of the hyoid bone fuse with the body at a certain age. The fusion of hyoid bonecan be of considerable help in estimating the age of unknown dead bodies.Aim of study: To analyze the fusion of hyoid bone in different age-groups.Materials and Methods: We studied a total of 50 cases. Hyoid bone was removed with extreme caution so as thebone does not break and be confused with fracture of hyoid bone. The structure of the bone and fusion of greatercornua to body of hyoid were studied. A master chart was prepared to store the data. The samples were placed incategories of five year age intervals.Results: A total of 30 males and 20 females comprised the study group. Maximum male and female cases were inthe age group 40-45 years. Unilateral fusion was observed in 23 cases; bilateral fusion was observed in 19cases; and non-fusion in 8 cases.Conclusion: From the results of present study, we conclude that non-fusion of greater cornua with body of hyoidbone is obsereved in cases of young age. Also, unialteral fusion and bilateral fusion is more commonly seen inthe age group 40-45 years age group.

Application of single segment and two segments of Dynesys fixation system in lumbar degenerative disease and comparison of short term therapeutic effects / 重庆医学

Objective To compare the short‐term clinical effects of single segment and two segments of Dynesys dynamic in‐ternal fixation system for treating lumbar degenerative disease .Methods 40 cases of degenerative lumbar disease treated by the Dynesys dynamic fixation system combined with posterior approach decompression from 2009 July to March 2012 were selected and performed the evaluation on the clinical effects by the waist and leg pain visual analogue scale (VAS) ,the Oswestry disability index (ODI) and the orthopaedic spinal association of North America (NASS) index .The imaging method was used to observe the mobili‐ty of operative segment and proximal adjacent segment and the degenerative change of intervertebral height .Results All of the 40 cases were followed up .The VAS score and ODI score at postoperative 3 months and last follow‐up were significantly decreased when compared with the pre‐operative scores (P 0 .05) .The NASS index showed no statistically significant difference in the postoperative effect satisfaction between the two groups (P>0 .05);there was no statistically significant difference in the variation of the intervertebral height between before operation and at the last follow‐up (P>0 .05) .There was statistically significant difference in the motility of proximal adjacent segment at the last follow‐up between the two groups (P<0 .05);but comparing the motility of proximal adjacent segment between the last follow‐up and pre‐operation , only the single segment group showed statistically significant difference (P< 0 .05) .Conclusion The Dynesys dynamic fixation system combined with posterior approach decompression operation has good clinical effect in the treatment of lumbar degenerative disease .Meanwhile ,the single segment method has more significant effect on the motility of proximal adjacent segment than the double segments method .

Segmental instrumentation plus vertebral augmentation for treatment of Denis type B thoracolumbar burst fracture / 中华创伤杂志

Objective To evaluate the effects of posterior segmental pedicle screw instrumentation and augmentation using calcium sulphate cement in treatment of Denis type B thoracolumbar burst fractures.Methods Forty patients with Denis type B thoracolumbar burst fracture treated between January 2011 and December 2012 were reviewed retrospectively.Twenty patients received posterior short-segment pedicle screw fixation in conjunction with screw placement at the level of fracture and calcium sulphate augmentation without posterolateral fusion (combined treatment group),but 20 patients underwent traditional short-segment pedicle screw fixation (conventional treatment group).Radiographs and CT scans evaluated local kyphotic angle on the spot of injury,anterior height of the injured vertebra,and canal encroachment before and after operation and at final follow-up.Meanwhile,visual analogue score (VAS),Oswestry disability index (ODI),and neurologic status based upon ASIA 2000 were assessed.Results Mean follow-up period was 15 months (range,12-24 months).Vertebral height restoration was equivalent of the two groups immediately after operation,but better result of kyphosis correction was found in treatment group than in control group (P ＜ 0.05).Anterior vertebral height and kyphotic angle significantly improved in treatment group compared to control group at final follow-up (P ＜ 0.05).Clinical and neurologic outcome evaluation were similar between the two groups.No implant failure occurred at follow-up.Conclusion For Denis type B thoracolumbar burst fractures,posterior segmental pedicle screw fixation augmented with calcium sulphate is effective for reducing correction loss and implant failure,compensating for the deficiencies of conventional fixation.

Posterior short-segment instrumentation without fusion for severe thoracolumbar burst fractures / 中华创伤杂志

Objective To evaluate the clinical efficacy of treatment of severe thoracolumbar burst fractures by posterior short-segment instrumentation without spinal fusion and assess radiographic imaging and function recovery after surgery.Methods Thirty-eight patients with severe monosegmental thoracolumbar burst fractures treated between July 2011 and March 2013 were analyzed retrospectively.Operation procedures were posterior short-segment pedicle screw distraction reduction and fixation combined with screw insertion to the injured vertebrae and calcium sulphate augmentation.In addition,there was no need for posterolateral interbody fusion.X-ray and CT were performed before and after operation to evaluate local kyphotic angle,anterior fractured vertebral body height and canal encroachment.Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before and after operation as well as in follow-up.Results All patients were followed up for average 14 months (range,3-20 months).Local kyphotic angle was (21.2 ±4.3)° before operation,(3.5 ± 1.8)°immediately after operation,and (4.8 ± 2.7) ° in final follow-up.Relative anterior vertebral height was (54.8 ± 14.6)％ before operation,(91.7 ± 8.0)％ after operation,and (87.2 ± 6.0)％ in final follow-up.Mean canal encroachment was (48.0 ± 4.5)％ preoperatively,(23.8 ± 7.8)％postoperatively,and (8.8 ± 4.6) ％ in final follow-up.In final follow-up,six patients with American Spinal Injury Association (ASIA) grade C on admission showed improvement to grade D (n =2) and grade E (n =4) ; 10 patients with ASIA grade E on admission showed improvement to grade E; 22 patients with grade E had no changes.ODI and VAS scored 15.5 ±8.8 and 2.3 ±0.8 in final follow-up with substantial improvement from those before operation (P ＜ 0.01).Complications from internal fixation were not found during follow-up.Conclusion Posterior short-segment fixation without fusion is one of the foremost effective methods for severe thoracolumbar burst fractures,for it can effectively restore the sagittal spinal alignment and the fractured vertebral body height.

NFlex Dynamic Stabilization System : Two-Year Clinical Outcomes of Multi-Center Study

OBJECTIVE: Pedicle-based dynamic stabilization systems, in which semi-rigid rods or cords are used to restrict or control spinal segmental motion, aim to reduce or eliminate the drawbacks associated with rigid fusion. In this study, we analyzed the two-year clinical outcomes of patients treated with the NFlex (Synthes Spine, Inc.), a pedicle-based dynamic stabilization system. METHODS: Five sites participated in a retrospective study of 72 consecutive patients who underwent NFlex stabilization. Of these 72 patients, 65 were available for 2-year follow-up. Patients were included based on the presence of degenerative disc disease (29 patients), degenerative spondylolisthesis (16 patients), lumbar stenosis (9 patients), adjacent segment degeneration (6 patients), and degenerative lumbar scoliosis (5 patients). The clinical outcome measures at each assessment were Visual Analogue Scale (VAS) to measure back pain, and Oswestry Disability Index (ODI) to measure functional status. Radiographic assessments included evidence of instrumentation failure or screw loosening. RESULTS: Sixty-five patients (26 men and 39 women) with a mean age of 54.5 years were included. Mean follow-up was 25.6 months. The mean VAS score improved from 8.1 preoperatively to 3.8 postoperatively, representing a 53% improvement, and the ODI score from 44.5 to 21.8, representing a 51% improvement. Improvements in pain and disability scores were statistically significant. Three implant-related complications were observed. CONCLUSION: Posterior pedicle-based dynamic stabilization using the NFlex system seems effective in improving pain and functional scores, with sustained clinical improvement after two years. With appropriate patient selection, it may be considered an effective alternative to rigid fusion.

Open Reduction without Fusion of Bilateral Jumped Lumbosacral Facet Dislocation Associated with Symphysis Pubis Separation and Cauda Equina Syndrome: Case Report

This paper reports a rare case of a lumbosacral dislocation associated with symphysis pubis separation and cauda equina syndrome. A 39-year-old male who diagnosed traumatic lumbosacral dislocation underwent an open reduction without fusion. After an open reduction and internal fixation of a symphysis pubis separation, a missed lumbosacral dislocation was diagnosed and an open reduction was performed without fusion. Due to the symphysis pubis separation, the patient was not allowed weight bearing for 3 months, which then began from wheel chair ambulation. At the 6-month follow up evaluation, there was no back pain but the patient reported mild S1 nerve root sensory symptoms. Lumbosacral dislocation is common in high energy polytrauma patients and can be misdiagnosed. However, prompt reduction without fusion is a good alternative treatment.

Posterior single segment fusion or non-fusion in treatment of lumbar spinal disease:a comparative study / 中国矫形外科杂志

[Objective]To compare the treatment effects between posterior single segment fusion or non-fusion in lumbar spinal disease,and to evaluate their influence on adjacent segments.[Method]Thirty-two cases of degenerative lumbar spinal disorders were treated with Coflex(group non-fusion) and PLIF(group fusion),and followed up for over 2 years.The clinical effect was evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI).Range of motion(ROM) of lumbar segments was measured by X-ray film.[Result]In group non-fusion,VAS decreased from 7.8?1.2 pre-operatively to 2.1?0.6 at final follow-up,ODI from 30.8?3.2 to 4.6?1.2,ROM improved significantly.In group fusion,VAS decreased from 7.2?1.1 to 2.0?0.6,ODI from 29.9?3.0 to 4.5?0.9,and ROM of L3、4 improved significantly.No significant difference of clinical effect was found between 2 groups.[Conclusion]Both fusion and non-fusion fixation have satisfying effects in treatment of degenerative lumbar spinal disorder.Non-fusion fixation has less influence on ROM of lumbar segments and could reduce adjacent segment degeneration.

Diagnosis and treatment of discogenic pain / 中国矫形外科杂志

The discogenic back pain has been paid more and more attention to.It is lumbar intervertebral disc degenerative disease without performance of pressure to nerve tissue(that is,except for lumbar disc herniation,lumbar spinal stenosis,etc.).The pathogenesis and diagnostic method was investigated in a large number of studies.A number of attempts have also been carried out in the treatment.Minimally invasive treatment,integration and non-fusion surgery have achieved good efficacy.This article summarizes the diagnosis and new progress in treatment of this disease,at the same time looks to the future development.

Results of Non-fusion Method in Thoracolumbar and Lumbar Spinal Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study of surgically managed patients. OBJECTIVES: To evaluate the results of posterior stabilization of a thoracolumbar fracture, without fusion, followed by the removal of metal implants within an appropriate period. Changes in the sagittal alignment and the restoration of segmental motion were also investigated. SUMMARY OF LITERATURE REVIEW: In managing unstable thoracolumbar and lumbar fractures, posterior fusion, using a transpedicular screw system, has been the treatment of choice, but results in the permanent loss of segmental motion. MATERIALS AND METHODS: Twelve patients with thoracolumbar and lumbar spine fractures, under 40 years of age (mean 28.4 years), were managed using this non-fusion method. Implants were removed at mean 9.2 months after the initial fixation of the fracture. For metal-fixed segments, the sagittal alignment, such as the angle of kyphosis, height of body, recovered motion range in flexion-extension and right-left bending view, were measured radiologically and compared with a control group. Clinical aspects, such as gross deformity and functional ability, were also investigated. RESULTS: The average sagittal angle at the time of injury was average 17.2 degrees, but became 1.7 degrees post-fixation, which increased after removal of the implants, reaching 9.8 degrees at the final follow up. The height of the fractured body was maintained until the final follow-up. The mean segmental motion measured in the sagittal and coronal planes were 11.7 and 9.5 degrees, respectively. Most patients were satisfied with the final gross appearance and functional outcomes. Only one patient showed considerable development of kyphotic angulation, but the functional outcome was good. CONCLUSION: The author's non-fusion method seems to be effective in achieving stability and sagittal alignment, as well as in regaining segmental motion of the fixed segments. The non-fusion method seems to be an effective method for managing thoracolumbar fractures, especially for young active persons.